Aggressive BP control may ward off haemorrhagic stroke in patients with past ischaemic strokes

Intensive blood pressure (BP) control helps reduce the risk of haemorrhagic stroke in patients with a history of ischaemic stroke, according to a post hoc analysis of the RESPECT* study.

RESPECT randomly assigned 1,280 patients with a history of cerebral infarction or intracerebral haemorrhage to receive intensive (BP <120/80 mm Hg) or standard (BP <140/90 mm Hg) BP control regimens.

The current post hoc analysis looked at 1,074 patients who had a history of cerebral infarctions, had a mean baseline BP of 140.7/81.4 mm Hg, and of whom 542 and 532 received standard and intensive BP control, respectively.

Over a mean follow-up of 3.9 years, researchers documented a rapid and sustained difference in systolic and diastolic BP between groups. Specifically, throughout the follow-up period, the mean BP in the standard- and intensive-control groups was 133.4/77.5 and 126.7/74.1 mm Hg, respectively, with a mean between-group difference of 6.7/3.4 mm Hg. Such a marked difference was apparent as early as 1 year after baseline.

Seventy-eight recurrent stroke episodes were documented during follow-up, most of which (89.7 percent; n=70) were ischaemic strokes; the remaining eight were intracranial haemorrhage (ICH).

The annualized rate for recurrent stroke (hazard ratio [HR], 0.81, 95 percent confidence interval [CI], 0.52–1.26; p=0.351) and ischaemic stroke (HR, 1.00, 95 percent CI, 0.63–1.60; p=0.999) did not differ between treatment groups. However, all eight ICH episodes occurred in the standard-control group, suggesting that its associated risk was suppressed by intensive treatment, though statistical estimates were incalculable due to the small number of cases.

*Recurrent Stroke Prevention Clinical Outcome