No Effect of BP Lowering on Cognition After Lacunar Stroke

NICE, France — A new analysis from the SPS3 (Secondary Prevention of Small Subcortical Strokes) trial shows no effect of blood pressure lowering on cognition among patients with lacunar stroke, although the follow-up time may be insufficient to show such an effect, investigators say.

The SPS3 trial, published last year in The Lancet and reported by Medscape Medical News at that time, suggested that lowering systolic blood pressure to a target of less than 130 mmHg in patients with recent lacunar stroke may be associated with a reduction in subsequent stroke.

A second arm of the trial, published previously in the New England Journal of Medicine, showed no benefit from combined aspirin and clopidogrel over aspirin alone in this same population.

The current presentation focused on whether lower vs higher blood pressure targets reduced cognitive decline in patients with recent lacunar stroke.

Presenting the analysis at the XXIII European Stroke Conference (ESC), Oscar R. Benavente, MD, University of British Columbia, Vancouver, Canada, explained that lacunar strokes and hypertension are both associated with cognitive impairment.

He pointed out that the blood pressure results of the study showed mean systolic values of 138 mmHg in the "higher" group and 127 mmHg in the "lower" group at 1-year follow-up, a difference of 11 mmHg that was maintained throughout the study.

The study included 2916 patients with baseline cognitive assessments. A total of 10,958 assessments were included in the current analysis — an average of 3.3 assessments per patient.

A modest nonsignificant decline in cognitive function occurred (as measured by the Cognitive Abilities Screening Instrument [CASI]-Z score) over the first year after lacunar stroke.

Table. CASI-Z Scores Over Course of SPS3 Study

Time of Assessment	Patients Assessed (n)	Mean CASI-Z Score
Baseline	2916	–0.59
1 y	2272	–0.40
2 y	1733	–0.35
3 y	1312	–0.34
4 y	933	–0.31
5 y	563	–0.39

CASI-Z scores did not differ between the 2 blood pressure groups (P = .30), and no difference was seen between the 2 antiplatelet regimens.

However, Dr. Benavente pointed out that the average follow-up for cognitive assessment was just 2.8 years.

"As hypertension takes a long time to show an effect, this may be too short a follow-up to determine any effect on cognition," he said. Other caveats were that the mean age of the population was relatively young at 63 years, and the patients had an average Mini-Mental State Examination score of 28.

The study was supported by the National Institutes of Health, National Institute of Neurological Disorders and Stroke. The authors have disclosed no relevant financial relationships.

XXIII European Stroke Conference (ESC). Presented May 7, 2014.

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