Intensive BP control beneficial for high-risk patients with history of cerebral infarction

Intensive blood pressure (BP) treatment to reduce BP below 120/80 mm Hg appears to protect against the risk of intracranial haemorrhage (ICH) but not that of ischaemic stroke when compared with standard BP treatment among patients with a history of cerebral infarction, according to a post hoc analysis of RESPECT.

RESPECT comprised 1,280 patients with a history of cerebral infarction or intracerebral haemorrhage and assigned to the intensive BP control group (BP target <120/80 mm Hg) or standard BP control group (BP target <140/90 mm Hg).

The current analysis included 1,074 patients (standard BP control, n=542; intensive BP control, n=532) who had a mean BP of 140.7/81.4 mm Hg at baseline. Over a mean follow-up of 3.9 years, a total of 78 first recurrent strokes occurred.

In the first year, the achieved BP was 132.0/77.5 mm Hg in the standard group and 123.9/72.6 mm Hg in the intensive group, for an average difference of 8.1 mm Hg in systolic BP. The mean BP throughout the follow-up was 133.4/77.5 mm Hg and 126.7/74.1 mm Hg, respectively.

Compared with standard treatment, intensive treatment tended to reduce overall annual stroke recurrence (1.74 percent vs 2.17 percent; p=0.351) and significantly reduced the risk of haemorrhagic stroke (0.00 percent vs 0.39 percent; p=0.005) but did not change the risk of ischaemic stroke (1.74 percent vs 1.75 percent; p=0.999).

The present data should be confirmed in other ethnicities. Additional trials are also warranted to identify which patients with a history of cerebral infarction should be treated with intensive BP treatment targeting <120/80 mm Hg for the prevention of ICH.