More Intensive Blood Pressure-Lowering May Benefit Secondary Stroke Prevention

More intensive blood pressure-lowering therapy, compared with less intensive therapy, was associated with a reduced risk of recurrent stroke in patients with stroke or transient ischemic attack, according to results from a systematic review and meta-analysis published online ahead of print in JAMA Neurology.

“This study suggests that more intensive differential blood pressure–lowering therapy may be beneficial for secondary stroke prevention,” wrote corresponding author Meng Lee, MD, of Chang Gung Memorial Hospital in Taiwan, and coauthors.

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The meta-analysis and meta-regression evaluated the association of more versus less blood pressure reduction and recurrent stroke in patients with stroke or transient ischemic attack. The analysis included 10 randomized clinical trials spanning 40,710 patients, of whom a third were women. Patients were followed for up to 4 years; the average follow-up duration was 2.8 years.

The risk of recurrent stroke with more intensive blood pressure lowering was 8.4%, according to the findings, compared with 10.1% with less intensive or no blood pressure lowering. The subsequent risk ratio with more intensive blood pressure lowering was 0.83.

“Further,” researchers wrote, “meta-regression suggested the magnitudes of both differential systolic blood pressure and diastolic blood pressure reduction were monotonically associated with a lower risk of recurrent stroke.”

More intensive blood pressure-lowering therapy was further linked with a reduced risk of major cardiovascular events, ischemic stroke, hemorrhagic stroke, fatal or disabling stroke, and death from cardiovascular causes, the study found.

“In the current study, greater achieved differential blood pressure lowering was beneficial even among patients at the lower end of the blood pressure spectrum,” researchers wrote. “The degree of separation between more intensive and less intensive systolic blood pressure lowering was associated with a uniform relative risk reduction.”

Reference

Hsu CY, Saver JL, Ovbiagele B, Wu YL, Cheng CY, Lee M. Association between magnitude of differential blood pressure reduction and secondary stroke prevention: a meta-analysis and meta-regression. JAMA Neurol. Published online March 20, 2023. doi: 10.1001/jamaneurol.2023.0218