Rigorous blood pressure control could halve recurrent stroke risk

Ensuring that the blood pressure (BP) of stroke survivors is controlled at least three-quarters of the time may halve their risk of a recurrence, shows a secondary analysis of the VISP trial.

The VISP (Vitamin Intervention for Stroke Prevention) trial included 3680 patients with stroke in the past 4 months. Among those whose baseline systolic BP (SBP) was above 153 mmHg (75th percentile), having controlled SBP on at least 75% of visits, versus less than 25%, during 2 years of follow-up was associated with a 54% reduced risk of recurrent stroke.

It was also associated with a 49% reduced risk of the combined outcome of stroke, myocardial infarction or vascular death, after accounting for confounders.

“It’s not enough to control blood pressure some of the time”, said lead study author Amytis Towfighi (University of Southern California, Los Angeles, USA) in a press statement. “Averages do not take into account variability in blood pressure readings from one check to the next.”

Indeed, the consistency of BP control correlated with average follow-up BP under control, and patients whose average BP during follow-up was controlled were 24% less likely to have either a recurrent stroke or the combined outcome than those in whom it was not.

The association between greater consistency of BP control and fewer subsequent events is a novel finding, say the researchers in Stroke.

Of note, VISP was not a BP intervention trial, but SBP was controlled at least 75% of the time in just 30% of patients; it was controlled 50% to 74% of the time in 19% of patients, 25% to 49% in 16% and less than 25% of the time in 35% of patients.

Patients with better controlled BP tended to be younger than other patients and were more likely to have a history of myocardial infarction and to be using lipid-lowering drugs and antithrombotics. They also had better lipid profiles and were less likely to have a history of hypertension or diabetes.

The team concludes: “These findings highlight the importance of ensuring BP is controlled at each poststroke clinical encounter, particularly among patients with elevated baseline SBP.”

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