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Cerebral White Matter Hyperintensities, Kidney Function Decline, and Recurrent Stroke After Intensive Blood Pressure Lowering: Results From the Secondary Prevention of Small Subcortical Strokes ( SPS 3) Trial.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2019 Feb 05; Vol. 8 (3), pp. e010091. - Publication Year :
- 2019
-
Abstract
- Background We aimed to determine whether cerebral white matter hyperintensities ( WMHs ) can distinguish stroke survivors susceptible to rapid kidney function decline from intensive blood pressure ( BP ) lowering. Methods and Results The SPS3 (Secondary Prevention of Small Subcortical Strokes) trial randomized participants with recent lacunar stroke to systolic BP targets of 130 to 149 and <130 mm Hg. We included 2454 participants with WMH measured by clinical magnetic resonance imaging at baseline and serum creatinine measured during follow-up. We tested interactions between BP target and WMH burden on the incidence of rapid kidney function decline (≥30% decrease from baseline estimated glomerular filtration rate at 1-year follow-up) and recurrent stroke. Rapid kidney function decline incidence was 11.0% in the lower- BP -target arm and 8.1% in the higher-target arm (odds ratio=1.40; 95% CI=1.07-1.84). Odds ratio for rapid kidney function decline between lower- and higher-target groups ranged from 1.26 in the lowest WMH tertile (95% CI , 0.80-1.98) to 1.71 in the highest tertile (95% CI , 1.05-2.80; P for interaction=0.65). Overall incidence of recurrent stroke was 7.9% in the lower-target arm and 9.6% in the higher-target arm (hazard ratio=0.80; 95% CI , 0.63-1.03). Hazard ratio for recurrent stroke in the lower-target group was 1.13 (95% CI , 0.73-1.75) within the lowest WMH tertile compared with 0.73 (95% CI , 0.49-1.09) within the highest WMH tertile ( P for interaction=0.04). Conclusions Participants with higher WMH burden appeared to experience greater benefit from intensive BP lowering in prevention of recurrent stroke. By contrast, intensive BP lowering increased the odds of kidney function decline, but WMH burden did not significantly distinguish this risk. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00059306.
- Subjects :
- Aged
Antihypertensive Agents administration & dosage
Blood Pressure drug effects
Creatinine blood
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Glomerular Filtration Rate physiology
Humans
Hypertension complications
Incidence
Magnetic Resonance Imaging
Male
Middle Aged
Prospective Studies
Recurrence
Renal Insufficiency epidemiology
Renal Insufficiency etiology
Stroke, Lacunar epidemiology
Stroke, Lacunar etiology
United States epidemiology
Antihypertensive Agents adverse effects
Blood Pressure physiology
Hypertension drug therapy
Renal Insufficiency prevention & control
Secondary Prevention methods
Stroke, Lacunar prevention & control
White Matter pathology
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 8
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 30686103
- Full Text :
- https://doi.org/10.1161/JAHA.118.010091