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Should Blood Pressure Targets After Lacunar Stroke Vary by Body Size? The SPS3 Trial.

Abstract：

BACKGROUND:It is unknown whether the physiological impact of a given blood pressure (BP) varies by body size. We explored interactions between higher vs. lower systolic BP (SBP) targets and anthropometric measures (body mass index (BMI), body surface area (BSA), height, weight) and recurrent stroke and death in the Secondary Prevention of Small Subcortical Strokes (SPS3) Trial. METHODS:Patients with recent magnetic resonance imaging-proven lacunar infarcts were randomized to 2 BP targets (130-149 mm Hg vs. <130) in a prospective, open-label, blinded end-point design. Time to outcome was evaluated with Cox proportional hazard models and compared between targets. We examined multiplicative interactions between each anthropometric measure and target and mean difference in achieved BP 1 year after randomization between BP groups by quartile. We also computed rates of recurrent stroke and death by quartiles of anthropometrics. RESULTS:Three thousand and twenty patients were followed over a mean of 3.7 (SD 2.0) years. Mean age was 63; 63% were male. Mean height was 167 (SD 11) cm, weight 81 (18) kg, BMI 29 (5.9) kg/m(2), and BSA 1.9 (0.25) m(2). Achieved BP at 1 year was comparable between quartiles for each anthropometric measurement. We found no consistent interactions between BP target and anthropometrics for either outcome, nor were there any significant associations between hazard of stroke or death when assessed by BMI, BSA, height, or weight. CONCLUSIONS:We found no interactions between BP target groups and quartiles of anthropometrics for rates of stroke and death in SPS3. There is no evidence at this time supporting body size-based modifications to current BP targets for secondary prevention after lacunar stroke. CLINICAL TRIALS REGISTRATION:Trial Number NCT00059306.

journal_name

Am J Hypertens

journal_title

American journal of hypertension

authors

Field TS,McClure LA,White CL,Pergola PE,Hart RG,Benavente OR,Hill MD,SPS3 Investigators.

doi

10.1093/ajh/hpu228

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

756-64

issue

6

eissn

0895-7061

issn

1941-7225

pii

hpu228

journal_volume

28

pub_type

杂志文章,多中心研究,随机对照试验

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