Abstract 95: The impact of Blood Pressure Variability on Stroke Recurrence: The SPS3 trial
Background: Blood pressure variability (BPV) has been identified as an independent and powerful risk factor for first and recurrent stroke. However, the role of visit-to-visit BPV in stroke patients with well-controlled blood pressure is not well defined.
Methods: Participants from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial were included. All participants had recent symptomatic MRI-proven lacunar infarcts. Visit-to-visit BPV was defined by average real variability (ARV; mean absolute difference from visit to visit), standard deviation (SD) and coefficient of variation (CV; equal to SD/mean). We analyzed the association between BPV and recurrence of stroke, myocardial infarction and death.
Results: There were 2666 participants included in the analysis with a mean of 13.7 followup visits per patient (36498 visits overall). Mean age was 63 y and 63% were male. Mean blood pressure was 132/72 and ARV was 12/7 mm Hg. There was no relationship between systolic or diastolic BPV and all recurrent stroke, nor was there a relationship between BPV and recurrent ischemic stroke or hemorrhagic stroke. After multivariable adjustment, increased systolic BPV was associated with all-cause mortality (HR 1.05 per mm Hg, 95% CI 1.03-1.08, p=0.0001) and MI (HR 1.05, 95% CI 1.01-1.97, p=0.02). There was a weak but significant correlation between systolic and diastolic ARV and average number of antihypertensive medications during the trial (systolic Spearman rank 0.214, p<0.0001, diastolic 0.135, p<0.0001). However, there was no relationship between ARV and stroke, regardless of the number of antihypertensives a patient was taking one year after randomization.
Conclusion: In this well-characterized population with symptomatic lacunar stroke and well-controlled blood pressure, visit-to-visit BPV was not associated with stroke recurrence. The directionality and nature of the relationship between BPV, MI and death is not well understood and requires further investigation. The lack of an association between BPV and stroke may have been precluded by aggressive and dynamic BP management in this cohort.
Author Disclosures: T.S. Field: Research Grant; Significant; Canadian Institutes of Health Research, Clinician Investigator Program, University of British Columbia. K. Patton: None. L. McClure: None. C. Sussman: None. C. White: None. P. Pergola: None. R. Hart: None. O. Benavente: Research Grant; Significant; NIH-NINDS. Other Research Support; Significant; BMS-Sanofi, study medication. Consultant/Advisory Board; Significant; Bayer, Otsuka.
- © 2014 by American Heart Association, Inc.