Does achieving an intensive versus usual blood pressure level prevent stroke?
Version of Record online: 27 JUL 2011
Copyright © 2011 American Neurological Association
Annals of Neurology
Volume 71, Issue 1, pages 133–140, January 2012
How to Cite
Lee, M., Saver, J. L., Hong, K.-S., Hao, Q. and Ovbiagele, B. (2012), Does achieving an intensive versus usual blood pressure level prevent stroke?. Ann Neurol., 71: 133–140. doi: 10.1002/ana.22496
- Issue online: 24 JAN 2012
- Version of Record online: 27 JUL 2011
- Accepted manuscript online: 2 JUN 2011 07:34AM EST
- Manuscript Accepted: 27 MAY 2011
- Manuscript Revised: 13 MAY 2011
- Manuscript Received: 23 MAR 2011
The purpose of this study was to compare the impact of achieving tight versus usual systolic blood pressure (SBP) control on stroke prevention through meta-analysis of randomized controlled trials.
We searched PubMed and bibliographies of recent review articles. Relative risk with 95% confidence interval was used as a measure of the association between an active treatment group with achieved SBP <130mmHg versus a comparator group with achieved SBP 130 to 139mmHg, and risk of stroke after pooling data across trials.
The search identified 11 studies with 42,572 participants and 794 stroke events. The final SBPs, weighted for trial size, were a mean of 126.5mmHg in the intensive treatment arms and 132.6mmHg in the conventional arms (mean SBP reduction, 6.1mmHg). Achieving a tight SBP level was associated with a lower stroke risk (relative risk, 0.80; 95% confidence interval, 0.70–0.92; p < 0.01) and a lower risk of major vascular events (0.91; 0.86–0.96; p < 0.001). In subgroup analyses, subjects with risk factors but no established cardiovascular disease showed substantial reduction of future stroke risk with tight control (0.49; 0.34–0.69), but those with established cardiovascular disease at entry did not experience stroke risk reduction with tight control (0.92; 0.83–1.03).
Achieving an SBP <130mmHg compared to 130 to 139mmHg appears to provide additional stroke protection only among people with risk factors but no established cardiovascular disease. ANN NEUROL 2012;71:133–140