SPS3-BP
Trial question
What is the effect of targeting lower SBPs in patients with recent lacunar stroke?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 3020
3020 patients (1117 female, 1903 male).
Inclusion criteria: patients with recent lacunar stroke.
Key exclusion criteria: disabling stroke, previous ICH (excluding traumatic), or cortical ischemic stroke.
Interventions
N=1501 lower BP target (SBP target < 130 mmHg).
N=1519 higher BP target (SBP target of 130-149 mmHg).
Primary outcome
Ischemic or hemorrhagic stroke
2.25%
2.77%
2.8 %
2.1 %
1.4 %
0.7 %
0.0 %
Lower blood pressure
target
Higher blood pressure
target
No significant
difference ↔
No significant difference in ischemic or hemorrhagic stroke (2.25% vs. 2.77%; HR 0.81, 95% CI 0.64 to 1.03).
Secondary outcomes
Significant decrease in intracerebral hemorrhage (0.11% vs. 0.29%; HR 0.37, 95% CI 0.15 to 0.95).
No significant difference in disabling or fatal stroke (0.72% vs. 0.89%; HR 0.81, 95% CI 0.53 to 1.23).
No significant difference in MI (0.62% vs. 0.7%; HR 0.88, 95% CI 0.68 to 1.04).
Safety outcomes
No significant differences in serious complications of hypotension, including syncope.
Conclusion
In patients with recent lacunar stroke, lower BP target was not superior to higher BP target with respect to ischemic or hemorrhagic stroke.
Reference
SPS Study Group, Benavente OR, Coffey CS et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013 Aug 10;382(9891):507-15.
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