Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke

作者：Kazuo Kitagawa, Yasumasa Yamamoto, Hisatomi Arima, Toshiki Maeda, Norio Sunami, Takao Kanzawa, 江口和男, Kenji Kamiyama, Kazuo Minematsu, Shinichiro Ueda, Hiromi Rakugi, Yusuke Ohya, Takahide Kohro, Koji Yonemoto, Yasushi Okada, Jitsuo Higaki, Norio Tanahashi, Genjiro Kimura, Satoshi Umemura, Masayasu Matsumoto, Kazuaki Shimamoto, Sadayoshi Ito, Takao Saruta, Kazuyuki Shimada · 发表于：JAMA Neurology · 年份：2019 · DOI：10.1001/jamaneurol.2019.2167 · 被引用次数：217 · 研究领域：Acute Ischemic Stroke Management、Blood Pressure and Hypertension Studies、Cerebrovascular and Carotid Artery Diseases

IMPORTANCE: The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that a systolic blood pressure (BP) target less than 120 mm Hg was superior to less than 140 mm Hg for preventing vascular events. This trial excluded patients with prior stroke; therefore, the ideal BP target for secondary stroke prevention remains unknown. OBJECTIVE: To assess whether intensive BP control would achieve fewer recurrent strokes vs standard BP control. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial (RCT) of standard vs intensive BP control in an intent-to-treat population of patients who had a history of stroke. Patients were enrolled between October 20, 2010, and December 7, 2016. For an updated meta-analysis, PubMed and the Cochrane Central Library database were searched through September 30, 2018, using the Medical Subject Headings and relevant search terms for cerebrovascular disease and for intensive BP lowering. This was a multicenter trial that included 140 hospitals in Japan; 1514 patients who had a history of stroke within the previous 3 years were approached, but 234 refused to give informed consent. INTERVENTIONS: In total, 1280 patients were randomized 1:1 to BP control to less than 140/90 mm Hg (standard treatment) (n = 640) or to less than 120/80 mm Hg (intensive treatment) (n = 640). However, 17 patients never received intervention; therefore, 1263 patients assigned to standard treatment (n = 630) or intensive treatment (n = 633) were analyzed. MAIN OU...