title: Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study.
abstract: OBJECTIVE
  Lowering blood pressure for secondary stroke prevention remains a challenge. These analyses were conducted to identify factors predicting achievement of SBP targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) study.
  
  
  METHODS
  SPS3 is a randomized trial assigning patients with lacunar stroke to two targets of SBP control (130-149 mmHg or <130 mmHg). Logistic regression models were used to identify patient and SPS3 site characteristics predictive of lowering SBP to target at the 12-month study visit.
  
  
  RESULTS
  Of those above target at baseline (n = 1041), 69% were within their assigned target at 12 months. In the model with baseline characteristics only, those receiving treatment for hypertension at baseline were 68% less likely to achieve target [odds ratio (OR) = 0.32; 95% confidence interval (CI) = 0.17-0.60], whereas those of Hispanic ethnicity were 1.49 times more likely (95% CI = 1.09-2.03) to achieve SBP target. When clinical site characteristics were added to the model, only treated hypertension at baseline remained significant. In addition, management at a larger site (OR = 1.51; 95% CI = 1.03-2.20), SBP in target at 6 months (OR = 2.39; 95% CI = 1.79-3.19), and medication adherence (OR = 2.73; 95% CI = 1.51-4.95) were positively associated with achieving target SBP. Missed appointments (OR = 0.55; 95% CI = 0.41-0.73) were negatively associated with lowering SBP to target at 12 months.
  
  
  CONCLUSIONS
  These results demonstrate that it is feasible to achieve targets of SBP control in this multiethnic stroke cohort across multiple sites and countries. The results highlight the important variables reflecting clinical site management.
authors.affiliation: Division of Nephrology and Hypertension College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Graves
authors.forename: Carole L
authors.initials: CL
authors.lastname: White
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Szychowski
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Pergola
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Coffey
authors.forename: Lindsey N
authors.initials: LN
authors.lastname: Hornung
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
mesh_terms: D000368:Aged; D001794:Blood Pressure; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control*