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Abstract: PO2092

The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Incident Strokes in the SPS3 Trial

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Boucher, Robert E., Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Ilkun, Olesya, Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, Division of Nephrology & Hypertension, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

In persons with low baseline diastolic blood pressure (DBP) and previous stroke, ntensive systolic blood pressure (SBP) lowering might by decreasing cerebral perfusion increase the risk for recurrent stroke.

Methods

SPS3 was a 2x2 factorial RCT that examined the effects of intensive vs. standatd (<130 vs. 130-149 mmHg) SBP control and combination versus asprin alone antiplatelet therapy on stroke outcome in 3020 participants. We examined whether the effects of intensive SBP lowering on stroke were modified by baseline DBP using spline regression models.

Results

Mean age was 63±11 yrs, 63% male and 15% black. Mean baseline SBP was 143±19 mmHg and DBP was 78±11 mmHg. There were 267 strokes over10725 person-years of follow-up. In spline regression models, those with lower baseline SBP were at higher risk for stroke (Fig1, panel A) but stroke incidence was lower in intensive vs. standard SBP arm all three baseline DBP tertiles (Fig1, panel B). In a spline regression model, there was no evidence that intensive SBP lowering increased the risk of stroke in those with low baseline DBP (Fig 2). Repeating the analysis with a cardiovascular composite (MI, CHF, stroke, or cardiovascular death) showed similar results.

Conclusion

While observational analysis suggested higher risk of recurrent stroke with low baseline DBP, intensive SBP lowering did not increase recurrent stroke risk in those with low baseline DBP and previous stroke.

Funding

  • NIDDK Support