Abstract WMP107: Factors Affecting Time to Achieve Assigned Blood Pressure Targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) Trial
INTRODUCTION: The NIH-funded SPS3 study examined two targets of systolic blood pressure (SBP) control for prevention of recurrent stroke: usual (130-149 mmHg) and intensive (<130 mmHg). Patients were recruited from the United States (US), Canada, Spain, and Latin America (LA). Evaluation of treatment efficacy depends upon the ability to achieve assigned SBP control levels. We examined regional differences and patient characteristics influencing time to achieve target.
METHODS: Cox proportional hazards models were used to model time to achieve in-target status, defined as two consecutive visits within assigned range. Regional effects were tested along with patient gender, age, medical indications, baseline SBP, and size of recruitment center. Scheduled SBP check attendance, active study participation and compliance status, and number of antihypertensive medications over time were also examined.
RESULTS: SPS3 recruited 3020 patients and SBP target groups were examined separately. Target was achieved after a median of 3 months in each group. Patients in LA achieved intensive control more quickly than in US (HR=1.45, 95% CI: 1.26-1.68); no regional differences were found for usual group. For intensive group, diabetes, higher baseline SBP and medications were associated with delayed control; large sites with increased control (Table). Male gender, active participation and compliance, and attendance of scheduled visits were associated with increased control in both groups (Table).
CONCLUSIONS: LA patients achieved intensive control more quickly than US patients but no other regional effects are noted. Adherence to scheduled visits and actively compliant study participation are the greatest indicators of target achievement. These results may aid planning and implementation of future international hypertension trials.
- © 2012 by American Heart Association, Inc.