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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESmall subcortical strokes (S3), or lacunar strokes, account for \u0026gt;25% of brain infarcts. Although S3 are the most common cause of vascular dementia, no clinical trials have focused on this stroke subtype. This article discusses blood pressure intervention results from the Secondary Prevention of Small Subcortical Strokes Trial [SPS3; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00059306\u0026amp;atom=%2Fspmdc%2F13%2F1%2F22.1.atom\u0022\u003ENCT00059306\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESmall subcortical strokes (S3), or lacunar strokes, account for \u0026gt;25% of brain infarcts. Although S3 are the most common cause of vascular dementia, no clinical trials have focused on this stroke subtype. Oscar R. Benavente, MD, University of British Columbia, Vancouver, Canada, reported blood pressure (BP) intervention results from the Secondary Prevention of Small Subcortical Strokes Trial [SPS3; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00059306\u0026amp;atom=%2Fspmdc%2F13%2F1%2F22.1.atom\u0022\u003ENCT00059306\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ESPS3 enrolled 3020 patients who had experienced lacunar strokes within 180 days, verified by MRI. The median time from the index event to randomization was 62 days. The mean patient age was 63 years, and 63% were male. Patients who had a cortical stroke, cardioembolic disease, and\/or carotid stenosis were not eligible for the trial.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the BP intervention portion of SPS3, patients were randomized to a higher systolic BP (SBP) target of 130 to 149 mm Hg (higher target group, n=1519) or a lower SBP target of \u0026lt;130 mm Hg (lower target group, n=1501). Antihypertensives were not discontinued at study entry, and BP medications were not specified by the study protocol.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary outcome was recurrent stroke. During a mean follow-up of 3.7 years, 277 first recurrent strokes occurred. The secondary outcomes were major vascular events, cognitive decline, or death.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe patients reached target BP at around 6 months. At 1 year, the average SBP for the higher target group was 138 mm Hg compared with 127 mm Hg for the lower target group. At the last observed visit, there was an average difference in SBP between the groups of 11 mm Hg.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EFor the primary outcome, the lower target group had an approximately 19% reduction in ischemic and hemorrhagic strokes compared with the higher target group, but this trend did not reach significance (HR, 0.81; 95% CI, 0.64 to 1.03; p=0.08). However, when ischemic and hemorrhagic strokes were separated, there was a significant reduction in intracerebral hemorrhage in the lower versus the higher target group (HR, 0.37; 95% CI, 0.15 to 0.95; p=0.03). The reduction in ischemic strokes did not reach significance after separating these events.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere were no significant differences between the lower and higher target groups in the secondary outcomes of major vascular events and death. The safety outcomes between the 2 groups were not significantly different, but more patients in the lower target group had complications due to hypotension (HR, 1.53; 95% CI, 0.80 to 2.93; p=0.20), particularly orthostatic syncope (HR, 2.18; 95% CI, 0.76 to 6.27; p=0.14).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Benavente said, \u201cAchieving a lower systolic blood pressure target was feasible, safe, and well tolerated.\u201d An SBP of \u0026lt;130 mm Hg significantly reduced intracerebral hemorrhage by two thirds, and a lower BP is likely to reduce recurrent stroke by approximately 20%, even though this trend did not reach significance. Although this is the only trial that has used target BP levels as an intervention, the results are consistent with data from previous trials of BP lowering after stroke.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/1\/22.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo31p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}