Blood Pressure Reduction and Secondary Stroke Prevention

Aristeidis H. Katsanos, Angeliki Filippatou, Efstathios Manios, Spyridon Deftereos, John Parissis, Alexandra Frogoudaki, Agathi Rosa Vrettou, Ignatios Ikonomidis, Maria Pikilidou, Odysseas Kargiotis, Konstantinos Voumvourakis, Anne Alexandrov, Andrei Alexandrov, Georgios Tsivgoulis

Research output: Contribution to journalReview article

32 Citations (Scopus)

Abstract

Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.

Original languageEnglish (US)
Pages (from-to)171-179
Number of pages9
JournalHypertension
Volume69
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Secondary Prevention
Stroke
Blood Pressure
Odds Ratio
Confidence Intervals
Antihypertensive Agents
Randomized Controlled Trials
Myocardial Infarction
Publication Bias
Risk Reduction Behavior
Meta-Analysis
Cause of Death
Placebos
Mortality
Therapeutics

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Katsanos, A. H., Filippatou, A., Manios, E., Deftereos, S., Parissis, J., Frogoudaki, A., ... Tsivgoulis, G. (2017). Blood Pressure Reduction and Secondary Stroke Prevention. Hypertension, 69(1), 171-179. https://doi.org/10.1161/HYPERTENSIONAHA.116.08485

Blood Pressure Reduction and Secondary Stroke Prevention. / Katsanos, Aristeidis H.; Filippatou, Angeliki; Manios, Efstathios; Deftereos, Spyridon; Parissis, John; Frogoudaki, Alexandra; Vrettou, Agathi Rosa; Ikonomidis, Ignatios; Pikilidou, Maria; Kargiotis, Odysseas; Voumvourakis, Konstantinos; Alexandrov, Anne; Alexandrov, Andrei; Tsivgoulis, Georgios.

In: Hypertension, Vol. 69, No. 1, 01.01.2017, p. 171-179.

Research output: Contribution to journalReview article

Katsanos, AH, Filippatou, A, Manios, E, Deftereos, S, Parissis, J, Frogoudaki, A, Vrettou, AR, Ikonomidis, I, Pikilidou, M, Kargiotis, O, Voumvourakis, K, Alexandrov, A, Alexandrov, A & Tsivgoulis, G 2017, 'Blood Pressure Reduction and Secondary Stroke Prevention', Hypertension, vol. 69, no. 1, pp. 171-179. https://doi.org/10.1161/HYPERTENSIONAHA.116.08485
Katsanos AH, Filippatou A, Manios E, Deftereos S, Parissis J, Frogoudaki A et al. Blood Pressure Reduction and Secondary Stroke Prevention. Hypertension. 2017 Jan 1;69(1):171-179. https://doi.org/10.1161/HYPERTENSIONAHA.116.08485
Katsanos, Aristeidis H. ; Filippatou, Angeliki ; Manios, Efstathios ; Deftereos, Spyridon ; Parissis, John ; Frogoudaki, Alexandra ; Vrettou, Agathi Rosa ; Ikonomidis, Ignatios ; Pikilidou, Maria ; Kargiotis, Odysseas ; Voumvourakis, Konstantinos ; Alexandrov, Anne ; Alexandrov, Andrei ; Tsivgoulis, Georgios. / Blood Pressure Reduction and Secondary Stroke Prevention. In: Hypertension. 2017 ; Vol. 69, No. 1. pp. 171-179.
@article{5c7ca0feaabf4cd1b93cbebb62ba75b6,
title = "Blood Pressure Reduction and Secondary Stroke Prevention",
abstract = "Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95{\%} confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95{\%} confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95{\%} confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.",
author = "Katsanos, {Aristeidis H.} and Angeliki Filippatou and Efstathios Manios and Spyridon Deftereos and John Parissis and Alexandra Frogoudaki and Vrettou, {Agathi Rosa} and Ignatios Ikonomidis and Maria Pikilidou and Odysseas Kargiotis and Konstantinos Voumvourakis and Anne Alexandrov and Andrei Alexandrov and Georgios Tsivgoulis",
year = "2017",
month = "1",
day = "1",
doi = "10.1161/HYPERTENSIONAHA.116.08485",
language = "English (US)",
volume = "69",
pages = "171--179",
journal = "Hypertension",
issn = "0194-911X",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Blood Pressure Reduction and Secondary Stroke Prevention

AU - Katsanos, Aristeidis H.

AU - Filippatou, Angeliki

AU - Manios, Efstathios

AU - Deftereos, Spyridon

AU - Parissis, John

AU - Frogoudaki, Alexandra

AU - Vrettou, Agathi Rosa

AU - Ikonomidis, Ignatios

AU - Pikilidou, Maria

AU - Kargiotis, Odysseas

AU - Voumvourakis, Konstantinos

AU - Alexandrov, Anne

AU - Alexandrov, Andrei

AU - Tsivgoulis, Georgios

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.

AB - Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.

UR - http://www.scopus.com/inward/record.url?scp=84994126479&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994126479&partnerID=8YFLogxK

U2 - 10.1161/HYPERTENSIONAHA.116.08485

DO - 10.1161/HYPERTENSIONAHA.116.08485

M3 - Review article

VL - 69

SP - 171

EP - 179

JO - Hypertension

JF - Hypertension

SN - 0194-911X

IS - 1

ER -