title: Intensive versus Guideline Blood Pressure and Lipid Lowering in Patients with Previous Stroke: Main Results from the Pilot 'Prevention of Decline in Cognition after Stroke Trial' (PODCAST) Randomised Controlled Trial.
abstract: Stroke is associated with the development of cognitive impairment and dementia. We assessed the effect of intensive blood pressure (BP) and/or lipid lowering on cognitive outcomes in patients with recent stroke in a pilot trial.
  
  
  
  In a multicentre, partial-factorial trial, patients with recent stroke, absence of dementia, and systolic BP (SBP) 125-170 mmHg were assigned randomly to at least 6 months of intensive (target SBP <125 mmHg) or guideline (target SBP <140 mmHg) BP lowering. The subset of patients with ischaemic stroke and total cholesterol 3.0-8.0 mmol/l were also assigned randomly to intensive (target LDL-cholesterol <1.3 mmol/l) or guideline (target LDL-c <3.0 mmol/l) lipid lowering. The primary outcome was the Addenbrooke's Cognitive Examination-Revised (ACE-R).
  
  
  
  We enrolled 83 patients, mean age 74.0 (6.8) years, and median 4.5 months after stroke. The median follow-up was 24 months (range 1-48). Mean BP was significantly reduced with intensive compared to guideline treatment (difference -10·6/-5·5 mmHg; p<0·01), as was total/LDL-cholesterol with intensive lipid lowering compared to guideline (difference -0·54/-0·44 mmol/l; p<0·01). The ACE-R score during treatment did not differ for either treatment comparison; mean difference for BP lowering -3.6 (95% CI -9.7 to 2.4), and lipid lowering 4.4 (95% CI -2.1 to 10.9). However, intensive lipid lowering therapy was significantly associated with improved scores for ACE-R at 6 months, trail making A, modified Rankin Scale and Euro-Qol Visual Analogue Scale. There was no difference in rates of dementia or serious adverse events for either comparison.
  
  
  
  In patients with recent stroke and normal cognition, intensive BP and lipid lowering were feasible and safe, but did not alter cognition over two years. The association between intensive lipid lowering and improved scores for some secondary outcomes suggests further trials are warranted.
  
  
  
  ISRCTN ISRCTN85562386.
authors.affiliation: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Philip M
authors.identifier: 0000-0003-2734-5132
authors.initials: PM
authors.lastname: Bath
authors.affiliation: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Polly
authors.initials: P
authors.lastname: Scutt
authors.affiliation: Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackburn
authors.affiliation: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.|Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Ankolekar
authors.affiliation: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Kailash
authors.initials: K
authors.lastname: Krishnan
authors.affiliation: Wolfson Centre for Age-Related Diseases, King's College London, Guy's Campus, London, United Kingdom.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Alistair
authors.initials: A
authors.lastname: Burns
authors.affiliation: General Practice & Primary Care Research Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.affiliation: Institute of Clinical Sciences, Queens University, Belfast, Royal Victoria Hospital, Belfast, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Passmore
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.affiliation: Department of Endocrinology, Royal United Hospital, Bath, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Reckless
authors.affiliation: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Nikola
authors.initials: N
authors.lastname: Sprigg
authors.affiliation: Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom.
authors.forename: Rob
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
authors.affiliation: Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ford
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood*; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation
chemical_list: D000960:Hypolipidemic Agents; D008055:Lipids