Someday our medical teams will figure out exactly what should be done for blood pressure lowering post-stroke. Maybe create a f*cking protocol and publish it for the world to see. Other research here:
9. New Treatment for Stroke Set to Increase Chances of Recovery - haemorrhage blood pressure lowering
The latest research here:
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2814%2970224-8/abstract
Prof Oscar R Benavente MD f
, for the SPS3 Investigators†Summary
Background
The
primary outcome results for the SPS3 trial suggested that a lower
systolic target blood pressure (<130 mm Hg) might be beneficial for
reducing the risk of recurrent stroke compared with a higher target
(130—149 mm Hg), but that the addition of clopidogrel to aspirin was not
beneficial compared with aspirin plus placebo. In this prespecified
secondary outcome analysis of the SPS3 trial, we aimed to assess whether
blood pressure reduction and dual antiplatelet treatment affect changes
in cognitive function over time in patients with cerebral small vessel
disease.
Methods
In
the SPS3 trial, patients with recent (within 6 months) symptomatic
lacunar infarcts from 81 centres in North America, Latin America, and
Spain were randomly assigned, in a two-by-two factorial design, to
target levels of systolic blood pressure (1:1; 130—149 mm Hg vs <130 mm Hg; open-label) and to a once-daily antiplatelet treatment (1:1; aspirin 325 mg plus clopidogrel 75 mg vs
aspirin 325 mg plus placebo; double-blind). For this analysis, the main
cognitive outcome was change in Cognitive Abilities Screening
Instrument (CASI) during follow-up. Patients were tested annually for up
to 5 years, during which time the mean difference in systolic blood
pressure was 11 mm Hg (SD 16) between the two targets (138 mm Hg vs 127 mm Hg at 1 year). We used linear mixed models to compare changes in CASI Z scores over time. The SPS3 trial is registered with ClinicalTrials.gov, number NCT00059306.
Findings
The
study took place between March 23, 2003, and April 30, 2012. 2916 of
3020 SPS3 participants (mean age 63 years [SD 11]) with CASI scores at
study entry were included in the analysis, with a median follow-up of
3·0 years (IQR 1·0—4·9). Mean changes in CASI Z scores from study
entry to assessment at years 1 (n=2472), 2 (n=1968), 3 (n=1521), 4
(n=1135), and 5 (n=803) were 0·12 (SD 0·83), 0·15 (0·84), 0·16 (0·95),
0·19 (0·99), and 0·14 (1·09), respectively. Changes in CASI Z
scores over time did not differ between assigned antiplatelet groups
(p=0·858) or between assigned blood pressure target groups (p=0·520).
There was no interaction between assigned antiplatelet groups and
assigned blood pressure target groups and change over time (p=0·196).
Interpretation
Cognitive
function is not affected by short-term dual antiplatelet treatment or
blood pressure reduction in fairly young patients with recent lacunar
stroke. Future studies of cognitive function after stroke should be of
longer duration or focus on patients with higher rates of cognitive
decline.
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