Back to Search
Start Over
Functional health and white matter hyperintensities as effect modifiers of blood pressure-lowering on cognitive function and vascular events in older Secondary Prevention of Small Subcortical Strokes trial participants.
- Source :
-
Journal of hypertension [J Hypertens] 2020 Aug; Vol. 38 (8), pp. 1578-1585. - Publication Year :
- 2020
-
Abstract
- Objective: To determine whether cerebral small vessel disease or disability modify the effect of SBP treatment on cognitive and vascular outcomes in older patients with recent lacunar stroke.<br />Methods: Participants aged at least 65 years of the Secondary Prevention of Small Subcortical Strokes Trial were randomized to a higher (130-149 mmHg) or lower (<130 mmHg) SBP target. The primary outcome was change in cognitive function (Cognitive Abilities Screening Instrument); secondary outcomes were incident mild cognitive impairment, stroke, major vascular events (all-stroke, myocardial infarction), and all-cause death. Results were stratified by severity of white matter hyperintensities (WMH; none/mild, moderate, severe) on baseline MRI, and by disability (no vs. at least one limitation in activities of daily living).<br />Results: One thousand, two hundred and sixty-three participants (mean age 73.8 ± 5.9 years, 40% women) were included. Participants with severe WMH or disability had worse cognitive function at baseline and after a mean follow-up of 3.9 years. No significant interactions existed between treatment group and effect modifiers (WMH, disability) for change in cognitive function (P for interaction 0.42 and 0.66, respectively). A lower SBP target appeared more beneficial among those with worse WMH burden for vascular outcomes (P for interaction = 0.01 for stroke and 0.03 for major vascular events).<br />Conclusion: There was no difference in the effect of lowering SBP to less than 130 mmHg on cognitive function by cerebral small vessel disease or disability among older adults with a history of lacunar stroke. Those with evidence of small vessel disease may derive greater benefit from lower SBP on prevention of subsequent vascular events.<br />Trial Registration: Clinicaltrials.gov Identifier: NCT00059306.
- Subjects :
- Aged
Aged, 80 and over
Clinical Trials, Phase III as Topic
Female
Humans
Male
Randomized Controlled Trials as Topic
Blood Pressure physiology
Cognition physiology
Stroke, Lacunar epidemiology
Stroke, Lacunar pathology
Stroke, Lacunar physiopathology
White Matter diagnostic imaging
White Matter pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5598
- Volume :
- 38
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of hypertension
- Publication Type :
- Academic Journal
- Accession number :
- 32371759
- Full Text :
- https://doi.org/10.1097/HJH.0000000000002440