title: Can blood pressure be lowered safely in older adults with lacunar stroke? The Secondary Prevention of Small Subcortical Strokes study experience.
abstract: OBJECTIVE
  To determine safety and tolerability of lowering blood pressure in older adults with lacunar stroke.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  The Secondary Prevention of Small Subcortical Strokes (SPS3) Trial, which compared the efficacy of two systolic blood pressure (SBP) targets (<130 mmHg and 130-149 mmHg) for secondary stroke prevention.
  
  
  METHODS
  Of 3,020 SPS3 participants, 494 aged 75 and older at baseline were used in these analyses.
  
  
  METHODS
  Rates of side effects related to lowering SBP and clinical outcomes, including stroke recurrence and vascular death, were examined.
  
  
  RESULTS
  Older participants achieved SBP levels similar to those of younger participants (mean SBP of 125 mmHg and 137 mmHg in lower and higher SBP target groups, respectively). At least once during the approximately 3.5 years of follow-up, 21% reported dizziness, and 15% reported lightheadedness when standing; the only significant difference between the younger and older groups was unsteadiness when standing (23% vs 32% respectively, P < .001). There was no difference according to treatment group. In younger adults, recurrent stroke was less likely in the lower than the higher SBP group (hazard ratio (HR) = 0.77, 95% confidence interval (CI) = 0.59-1.01) but not in older participants (HR = 1.01, 95% CI = 0.59-1.73), although the interaction was not significant (P = .39). The lower SBP target was associated with a significant reduction in vascular death in older participants (HR = 0.42, 95% CI = 0.18-0.98), with a significant interaction between age and SBP group (P = .049).
  
  
  CONCLUSIONS
  Except for unsteadiness when standing, there was no difference according to age in individuals with lacunar stroke with respect to side effects potentially related to lowering blood pressure. Although the lower SBP target was not associated with lower likelihood of recurrent stroke, these exploratory analyses suggested a possible benefit related to vascular death.
authors: School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors: Carole L
authors: CL
authors: White
authors: Jeff M
authors: JM
authors: Szychowski
authors: Pablo E
authors: PE
authors: Pergola
authors: Thalia S
authors: TS
authors: Field
authors: Robert
authors: R
authors: Talbert
authors: Helena
authors: H
authors: Lau
authors: Kalyani
authors: K
authors: Peri
authors: Oscar R
authors: OR
authors: Benavente
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020521:Stroke / Q000517:prevention & control; D059409:Stroke, Lacunar / Q000150:complications*
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure management; hypertension; ischemic stroke; lacunar stroke; stroke prevention