Format

Send to

Choose Destination
See comment in PubMed Commons below
Lancet. 2013 Aug 10;382(9891):507-15. doi: 10.1016/S0140-6736(13)60852-1. Epub 2013 May 29.

Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial.

Collaborators (473)

Benavente OR, Hart RG, Pergola PE, Palacio S, Castro I, Farias A, Roldan A, Kase C, Gavras I, Lau H, Ogrodnik M, Allen N, Meissner I, Graves J, Herzig D, Covalt J, Meyer B, Jackson C, Gamble P, Kelly N, Warner J, Bell J, Demaerschalk B, Hogan M, Wochos D, Wieser J, Cleary B, Wood L, Hanna J, Zipp T, Bailey S, Cook D, Liskay A, Simcox D, Kappler J, Anderson D, Grimm R, Brauer D, Pettigrew C, Vaishnov A, Sawaya P, Fowler A, Hughes N, Rice J, Vanderpool K, Cruz-Flores S, Walden HD, Holzemer E, Santhakumar S, Van Stavern R, Chatuverdi S, Flack J, Mada F, Wiseman D, Berlow E, Klinker J, Chiu D, Taylor A, Katz L, Coull B, Howard L, Malekniazi M, VanSkiver M, Bruck D, Redman S, Logan W, Carpenter D, Schroer S, Katramados A, Silver B, Yee J, Aiello K, Wilson K, McCarthy S, Dandapani B, Spies CP, Vasile C, Anthony B, Ferguson J, Krubel S, Synman A, Andrews N, Kirshner H, Sussman C, Brown D, Elkind M, Crew RJ, Radhakrishan J, Corporan TE, Diaz J, Aragon R, Slivka A, Spetie D, Agriesti J, Notstein P, Naritoku D, Zweifler R, Culpepper M, Parnell M, Yunker R, Boots K, Drinkard R, Backlin R, Benesch C, Bisognano J, Leonhardt A, Zentner J, Hildreth M, Johnson M, Liu Y, Goldsteen R, Blair A, Wright G, Gathua N, Book D, Eapen S, Grimm C, Blaney B, Rozman S, Gaertner L, Bradenburg E, Loomis L, Monarch-Cotton J, Ravavelli-Meyer J, Golembieski A, Burgin SW, Hollander J, Polashenski W, Wallace P, Weber C, Lutsep H, Girard D, Seisler K, Cingel M, Ross M, Stone R, Larsen D, Doherty A, David L, Levy P, Buchheimer N, Vaughn S, Smith E, Satterfield J, Tirschwell D, Logar C, Ryan M, Schubert G, Tanzai P, Mirsen T, McAllister S, Bastien A, Niblack P, Frey J, Darbonne C, Karanjia P, Murali N, Dart R, Mancl K, Atkinson R, Lieberman R, Carter T, Zrelak P, Kenney N, Jacoby M, Jones D, DeFrancisco J, Hamm T, Romano J, Ortiz G, del Carmen Lichtenberger M, Linas R, Kravet S, Alt J, Sundararajan S, Rahman M, Horvath T, Korosec D, Murphy C, Greenberg J, Lennihan L, King M, Tenteromano L, Frankel M, Doyle J, Braimah J, Pereira L, Ching M, Sawyer R, Parkes K, Conover C, Albakri E, Ramirez G, Segal S, Taylor K, Jackson J, Helgason K, Hillmann M, Ringel R, Fleming N, Mckown B, Cohen S, Jenders R, Singh R, La MT, Trinh K, Weinberger J, Wright L, Burch D, Horowitz R, Atlas S, Augustine S, Van Stavern R, Brown A, Serna J, Newgent J, Naylor J, Carpenter L, Warwick T, Stoltz S, Garcia R, Scheck M, Chadwick L, Fleck J, Weinberger M, Sears A, Fanale C, Neeper L, Fisk P, Cohen S, Sabry D, Phoenix R, Tong D, Garcia M, Mackey A, Morin J, Haché A, Lessard C, Côté R, Green L, Wadup L, Fontaine AM, Gubitz G, Rebello R, Dean T, Reidy Y, Sharma M, Stotts G, Clark H, Mortensen M, Sauve J, Sharma D, Savage M, Minuk J, Trudeau L, Schanz C, Berger L, Brunet S, Pontbriand J, Mainville M, Racicot D, Hill M, Fischer K, Cole-Kaskayne A, Keeney C, Shuab A, Khan K, Dean N, Herbert F, Kastelic K, Pretell EJ, Valdivia J, Pretell M, del Brutto O, Santibáñez R, Lara J, Zambrano M, Arauz A, Cervantes GA, Leyva A, Camacho I, Ruiz Sandoval JL, Salcido Vásquez E, Ruiz C, Cantú Brito C, Fernández M, Góngora-Rivera JF, Escamilla JM, Moxica J, Arciniega G, Gonzalez WJ, Matamala G, Goecke H, Parra M, Pozo J, Tapia J, Godoy IE, Valdes M, Estol C, Peralta C, Ellenberg A, Chezzio D, Fernández Pardal MM, Trimachi H, Bonardo P, Mazziotti J, Rey RC, Caruso G, Melamud L, Lepera S, Stilman AP, Ameriso S, Sánchez R, Bruera G, Moschini J, Ramírez MJ, Bueri JA, Sevilla S, de Ambrosi B, Marinsalta G, Rubio F, Krupinski Y, Carvajal A, Roquer J, Oliveras Serrano A, Jiménez Conde J, Rodríguez A, Romeral G, Arboix A, Pelegrí A, Blanco L, Cánovas Vergé D, Estela Herrero J, Gómez A, Blanco L, Leal JS, Castellanos M, Cruz V, Cepeda M, Gomis M, Arenillas J, Dávalos A, Suñol A, Reverté S, Lluis J, Sergio MV, Marín R, Castillo Sánchez J, Blanco M, Rodríguez M, Jiménez I, Rodríguez J, Díez Tejedor E, Martínez P, Fuentes B, Soler Singla L, Balaguer E, Izquierdo J, Soler C, Armenteros M, Benavente OR, Hart RG, Pergola PE, Shepherd A, Roldan A, Benavente MF, White C, Robu C, Kelly C, Talbert R, Martinez E, Bazan C, Pergola G, Pearce LA, Costello R, Jacova C, Camelia L, Mendoza C, Pratt B, Kin B, Holliday S, McClure LA, Coffey C, Szychowski JM, Howard G, Katholi C, Zhang Y, Peri K, Allcorn C, Mailhot R, Irby L, Guyton F, Sewell MJ, Ringer R, Raisch D, Hunt D, Rubio F, Rosso CM, Martin A, Sanllorente M, Arabetti C, Luis Fernández J, Cremona MJ, Capece A, Benavente OR, Hart RG, Benavente MF, Coffey C, Conwit R, McClure LA, Pergola PE, Roldan A, Szychowski JM, Talbert R, Benavente OR, Anderson D, Arauz A, Benavente MF, Coffey C, Conwit R, Côté R, Demaerschalk B, del Brutto O, Elkind M, Hart RG, Kase C, McClure LA, Moy C, Pergola PE, Roldan A, Sharma M, Szychowski JM, Talbert R, White C, White C, Benavente OR, Benesch C, Coffey C, Conwit R, Graves J, Grimm R, Gubitz G, Holliday S, Lau H, Moy C, Pearce LA, Szychowski JM, Aguilar M, Sherman D, Nasco E, Blackshear J, Chung M, Fayad P, Gage B, Johnston C, Kernan W, Leira E, Merino J, Roman G, Sila C, Sung G, van Walraven C, Zweifler R, Stern B, Conwit R, Moy C, Welch KM, Clarke W, Cutler J, Furie K, Johnston K, Mayo M, Coffey CS.

Erratum in

  • Lancet. 2013 Aug 10;382(9891):506. Coffey, C S [aded].

Abstract

BACKGROUND:

Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. We investigated the effects of different blood-pressure targets on the rate of recurrent stroke in patients with recent lacunar stroke.

METHODS:

In this randomised open-label trial, eligible patients lived in North America, Latin America, and Spain and had recent, MRI-defined symptomatic lacunar infarctions. Patients were recruited between March, 2003, and April, 2011, and randomly assigned, according to a two-by-two multifactorial design, to a systolic-blood-pressure target of 130-149 mm Hg or less than 130 mm Hg. The primary endpoint was reduction in all stroke (including ischaemic strokes and intracranial haemorrhages). Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT 00059306.

FINDINGS:

3020 enrolled patients, 1519 in the higher-target group and 1501 in the lower-target group, were followed up for a mean of 3·7 (SD 2·0) years. Mean age was 63 (SD 11) years. After 1 year, mean systolic blood pressure was 138 mm Hg (95% CI 137-139) in the higher-target group and 127 mm Hg (95% CI 126-128) in the lower-target group. Non-significant rate reductions were seen for all stroke (hazard ratio 0·81, 95% CI 0·64-1·03, p=0·08), disabling or fatal stroke (0·81, 0·53-1·23, p=0·32), and the composite outcome of myocardial infarction or vascular death (0·84, 0·68-1·04, p=0·32) with the lower target. The rate of intracerebral haemorrhage was reduced significantly (0·37, 0·15-0·95, p=0·03). Treatment-related serious adverse events were infrequent.

INTERPRETATION:

Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial.

FUNDING:

National Institutes of Health-National Institute of Neurological Disorders and Stroke (NIH-NINDS).

PMID:
23726159
PMCID:
PMC3979302
DOI:
10.1016/S0140-6736(13)60852-1
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center