COMMENTARY

Aggressive Blood Pressure Lowering After Stroke Yields Mixed Outcomes

Tejas P. Desai, MD

Disclosures

May 09, 2016

The Study

SPS3 studied 3020 patients to determine whether one of two interventions, or both, had a protective, secondary preventive effect on the development of a stroke. Would dual antiplatelet therapy with aspirin plus clopidogrel versus aspirin alone, and/or aggressive blood pressure lowering (systolic < 130 mm Hg), protect a patient in the immediate poststroke period? All of the enrolled patients had an estimated glomerular filtration rate (eGFR) of ≥ 40 mL/min/1.73 m2. A subset of these patients (mean eGFR nearly 80 mL/min/1.73 m2) had their kidney function serially measured throughout the intervention period; it was these 2610 patients who formed the foundation upon which the current investigation was conducted.

In both the aggressively controlled and lax blood pressure arms, kidney function declined quickly. Within the first year after a stroke, the overall decline in eGFR was -3.2 mL/min/1.73 m2 (not statistically significant). The rate of eGFR decline, however, was greater in the aggressively controlled blood pressure group (statistically significant). Of note, after the immediate 1-year poststroke period, the yearly rates of eGFR decline were of small and nearly equal magnitude.

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