Dr. Benavente told reporters that while BP lowering is recommended for stroke patients in other guidelines, there are no set BP targets.
Patients in SPS3 had an imaging-verified lacunar stroke within 180 days of study entry and were followed for a mean of 3.7 years. There were 1,519 patients in the higher-target group and 1,501 in the lower-target group. Their baseline diastolic BPs were 80 mm Hg and 78 mm Hg. They were on an average of 1.4 and 1.2 BP medications at study entry, and 1.4 and 1.3 at 1 year. Blood pressure medications were not specified by protocol.
Antihypertensives were not discontinued at study entry. At last visit, 60% of the higher-target group and 78% of the lower-target group were on an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, 39% vs. 43% on a calcium channel blocker, and 38% vs. 54% on thiazides.
At the last observed visit, the average systolic BP difference between groups was 11 mm Hg. Major vascular events, defined as stroke, MI, and vascular deaths, occurred in 3.4% of the higher-target group (188 events) vs. 3.0% of the lower-target group (160 events) (HR,0.84; P = .10), Dr. Benavente said.
SPS3 is sponsored by the National Institute of Neurological Disorders and Stroke (NINDS). Sanofi-Aventis and Bristol-Myers Squibb donated the study drugs. Dr. Benavente has received research support from NINDS. Dr. Greenberg reported receiving research grants from the National Institutes of Health and serving as a consultant/advisory board member for Hoffman-La Roche. Dr. Gorelick reported having no relevant financial disclosures.