BP results from the SPS3 pilot study

Abstract

Small Sub-cortical Strokes (S3) comprise about 27% of brain infarctions and are present in 20% of patients >65 years; 150,000 symptomatic S3 occur each year. They are the commonest cause of vascular dementia and 80% of patients also have hypertension. It is not known what the optimal BP target is, to prevent recurrence of S3. SPS3 is a new 5-year NIH-funded study to determine whether SBP should be treated to 130–149mmHg, or to <130mmHg, and whether aspirin should be given alone, or with clopidogrel to prevent S3 recurrence and vascular dementia. We here describe the results, in a pilot study, of BP titration, in 66 symptomatic S3 patients, over up to 18 months, to these goal BP’s. JNCVI guidelines were generally followed. Mean age was 58y, 53% were male, mean time from stroke to study entry was 109 days, entry BP averaged 160/87mmHg on an average of 1.6 BP meds. Medication compliance was excellent in 41 and 34% (goal 130–149mmHg and <130mmHg respectively), good in 41 and 44% and poor in 15 and 19%, at the final visit. Adverse effects were seen in 65 and 50% but were generally very mild prompting medication change in 3% of each group. Median blood pressures were 141/75 and 129/70mmHg at the most recent visit, both within target. 24hr BP monitoring was done in 33pts: 6 increased nocturnal BP by 1–10%, 16 dipped by 0–9%, 1 by 10–20% and 1 by > 20%. This Pilot study shows we can, using a “Hypertension Expert”, control BP at widely separated target levels in these hard-to-treat patients who have shown, by having an S3, their poor prior BP control.