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. CONCLUSION: 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.
RCT Entities:
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. CONCLUSION: 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: H M Perry; B R Davis; T R Price; W B Applegate; W S Fields; J M Guralnik; L Kuller; S Pressel; J Stamler; J L Probstfield Journal: JAMA Date: 2000-07-26 Impact factor: 56.272
Authors: S E Kjeldsen; B Dahlöf; R B Devereux; S Julius; U de Faire; F Fyhrquist; H Ibsen; K Kristianson; O Lederballe-Pedersen; L H Lindholm; M S Nieminen; P Omvik; S Oparil; H Wedel Journal: Am J Hypertens Date: 2000-08 Impact factor: 2.689
Authors: Susan A Oliveria; Pablo Lapuerta; Bruce D McCarthy; Gilbert J L'Italien; Dan R Berlowitz; Steven M Asch Journal: Arch Intern Med Date: 2002-02-25
Authors: Y Tanizaki; Y Kiyohara; I Kato; H Iwamoto; K Nakayama; N Shinohara; H Arima; K Tanaka; S Ibayashi; M Fujishima Journal: Stroke Date: 2000-11 Impact factor: 7.914
Authors: Lars H Lindholm; Hans Ibsen; Björn Dahlöf; Richard B Devereux; Gareth Beevers; Ulf de Faire; Frej Fyhrquist; Stevo Julius; Sverre E Kjeldsen; Krister Kristiansson; Ole Lederballe-Pedersen; Markku S Nieminen; Per Omvik; Suzanne Oparil; Hans Wedel; Peter Aurup; Jonathan Edelman; Steven Snapinn Journal: Lancet Date: 2002-03-23 Impact factor: 79.321
Authors: L Hansson; A Zanchetti; S G Carruthers; B Dahlöf; D Elmfeldt; S Julius; J Ménard; K H Rahn; H Wedel; S Westerling Journal: Lancet Date: 1998-06-13 Impact factor: 79.321
Authors: Pablo E Pergola; Carole L White; Jeff M Szychowski; Robert Talbert; Oscar Del Brutto; Mar Castellanos; John W Graves; Gonzalo Matamala; Edwin Javier Pretell; Jerry Yee; Rosario Rebello; Yu Zhang; Oscar R Benavente Journal: Am J Hypertens Date: 2014-03-07 Impact factor: 2.689