COMMENTARY

Aggressive Blood Pressure Lowering After Stroke Yields Mixed Outcomes

Tejas P. Desai, MD

Disclosures

May 09, 2016

Analysis and Commentary

This analysis and SPRINT bring up an interesting dilemma: How aggressive should healthcare providers be in controlling blood pressure? Previous trials have shown limited benefits of aggressive lowering. Indeed, in the SPS3 trial, the risk for a subsequent stroke was not significantly altered by aggressively lowering blood pressure. The current study, while not large or randomized, raises multiple hypotheses that could be studied subsequently in a randomized fashion. At what blood pressure can one achieve secondary stroke prevention without a concomitant decline in renal function? If renal decline is observed, is it permanent? Do we really need to aggressively lower blood pressure in healthy patients for the primary prevention of chronic kidney disease? The analysis in the current study seems to suggest that aggressive blood pressure control in years 2-5 of the poststroke period did not erase the initial loss of kidney function in year 1.

A good study isn't restricted to large randomized trials. Studies such as the current investigation are equally valuable because they raise additional questions and point us in new directions. Figures 1 and 2 indicate what Twitter users think of this study. Share your thoughts with us in the comments section below.

Figures 1 and 2. Voting results from Twitter users.

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