title: Achieved blood pressures in the secondary prevention of small subcortical strokes (SPS3) study: challenges and lessons learned.
abstract: BACKGROUND
  Lowering blood pressure (BP) after stroke remains a challenge, even in the context of clinical trials. The Secondary Prevention of Small Subcortical Strokes (SPS3) BP protocol, BP management during the study, and achieved BPs are described here.
  
  
  METHODS
  Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: <130mm Hg, or higher: 130-149mm Hg. SBP management over the course of the trial was examined by race/ethnicity and other baseline conditions.
  
  
  RESULTS
  Mean SBP decreased for both groups from baseline to the last follow-up, from 142.4 to 126.7mm Hg for the lower SBP target group and from 143.6 to 137.4mm Hg for the higher SBP target group. At baseline, participants in both groups used an average of 1.7±1.2 antihypertensive medications, which increased to a mean of 2.4±1.4 (lower group) and 1.8±1.4 (higher group) by the end-study visit. It took an average of 6 months for patients to reach their SBP target, sustained to the last follow-up. Black participants had the highest proportion of SBP ≥150mm Hg at both study entry (40%) and end-study visit (17%), as compared with whites (9%) and Hispanics (11%).
  
  
  CONCLUSIONS
  These results show that it is possible to safely lower BP even to a SBP goal <130mm Hg in a variety of patients and settings, including private and academic centers in multiple countries. This provides further support for protocol-driven care in lowering BP and consequently reducing the burden of stroke.
authors.affiliation: Department of Medicine, University of Texas Health Sciences Center at San Antonio and Renal Associates PA, San Antonio, Texas;
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Pergola
authors.affiliation: School of Nursing, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas; whitec2@uthscsa.edu.
authors.forename: Carole L
authors.initials: CL
authors.lastname: White
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama;
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Szychowski
authors.affiliation: College of Pharmacy, University of Texas at Austin, Austin, Texas;
authors.forename: Robert
authors.initials: R
authors.lastname: Talbert
authors.affiliation: Department of Neurological Sciences, Hospital-Clínica Kennedy, and School of Medicine, Universidad Espíritu Santo-Ecuador, Guayaquil, Ecuador;
authors.forename: Oscar Del
authors.initials: OD
authors.lastname: Brutto
authors.affiliation: Department of Neurology, Hospital Universitari Dr. Josep Trueta of Girona, Barcelona, Spain;
authors.forename: Mar
authors.initials: M
authors.lastname: Castellanos
authors.affiliation: Division of Nephrology and Hypertension College of Medicine, Mayo Clinic, Rochester, Minnesota;
authors.forename: John W
authors.initials: JW
authors.lastname: Graves
authors.affiliation: Unidad de Neurologia, Hospital Naval A. Nef, Vina del Mar, Chile;
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Matamala
authors.affiliation: Hospital Alberto Sabogal, Lima, Peru;
authors.forename: Edwin Javier
authors.initials: EJ
authors.lastname: Pretell
authors.affiliation: Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan;
authors.forename: Jerry
authors.initials: J
authors.lastname: Yee
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Canada;
authors.forename: Rosario
authors.initials: R
authors.lastname: Rebello
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama;
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Division of Neurology, Department of Medicine, Brain Research Center, University of British Columbia, Vancouver, Canada.
authors.forename: Oscar R
authors.initials: OR
authors.lastname: Benavente
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D002985:Clinical Protocols; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D059409:Stroke, Lacunar / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents
keywords: achieved blood pressures; blood pressure; blood pressure management; hypertension; ischemic stroke; lacunar stroke; stroke prevention.