More Intensive Differential BP–Lowering Beneficial

A meta-analysis and a meta-regression of randomized clinical trials suggested that more intensive differential blood pressure (BP)–lowering may be beneficial for prevention of recurrent stroke and major cardiovascular events. The analysis included 10 randomized clinical trials comprising 40 710 patients (women 34%; mean age 65 years) with stroke or transient ischemic attack (TIA). The mean duration of follow-up was 2.8 years (range 1-4 years). Pooled results showed that more intensive treatment compared with less intensive was associated with a reduced risk of recurrent stroke in the patients (absolute risk, 8.4% vs 10.1%; risk ratio [RR], 0.83). Meta-regression showed that the magnitude of differential systolic blood pressure (SBP) and diastolic blood pressure (DBP) reduction was associated with a lower risk of recurrent stroke in the patients in a log-linear fashion (SBP: regression slope, −0.06; DBP: regression slope, −0.17). Similar results were found in the association between differential BP-lowering and major cardiovascular events including ischemic or hemorrhagic stroke, fatal or disabling stroke, and death from cardiovascular causes in the patients. The findings are consonant with and extend prior studies and support the current practice guidelines recommending BP-lowering to a SBP target of less than 130 mm Hg for patients with stroke or TIA, although secondary prevention guidelines recommend a less aggressive SBP target (<140 mm Hg) in patients with 50% to 99% stenosis of a major intracranial artery. These studies support a strategy of a moderate BP–lowering target during the first 6 months following stroke or TIA followed by a more aggressive target subsequently. The study also suggests that more intensive BP–lowering might be especially beneficial for Asian populations. Source: https://jamanetwork.com/