Lowering blood pressure after stroke or with diabetes poses challenges, in research and practice — SkimNews
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- spironolactone given right after a stroke in the small, diverse REDUCE trial was associated with a higher likelihood of blood pressure below 130/80 mm Hg at three months than usual post-stroke care; Jordana Cohen cited a 7 mm Hg reduction as associated with 38% lower recurrent-stroke risk, while REDUCE itself measured blood pressure rather than cardiovascular outcomes and was presented as an unpublished abstract.
- OPTIMAL-STROKE, published in the New England Journal of Medicine, tested a systolic goal of 120 mm Hg or lower against standard treatment below 140 in Brazil; those taking medication to reach the lower goal were significantly less likely within four years to die or experience a heart attack, stroke, hospitalization for chest pain or hospitalization for heart failure.
- OPTIMAL-DIABETES, also published in the New England Journal of Medicine, found that targeting systolic blood pressure below 120 rather than below 140 in people with type 2 diabetes did not reduce major cardiovascular events or deaths; Karla Santo called the result neutral and said the ideal target remains uncertain.
- Shawna Nesbitt noted differences between men and women and between younger and older patients across the two older trials and OPTIMAL-DIABETES, and said the results strongly suggest a more nuanced approach to hypertension treatment rather than lumping patients together.
- OPTIMAL-STROKE reported no increased risk of end-stage renal disease, the need for dialysis or deaths, but some renal-function markers were abnormal and electrolyte levels changed; reaching the lower target required medical supervision including kidney monitoring.
- Bruce Ovbiagele said one-third of stroke patients do not meet blood-pressure guidelines, while about one in five survivors have discontinued antihypertensive medications one year after a stroke.
- Cheryl Bushnell said doctors know what to do but struggle with how to manage post-stroke blood pressure, as care moves from hospital neurologists to primary care while coordination with nephrologists remains unclear.
Why it matters: For clinicians and stroke survivors, the stakes are concrete: about one in five survivors stop antihypertensive medication within a year, while OPTIMAL-STROKE linked a systolic target of 120 or lower with fewer deaths and cardiovascular events within four years than the standard below 140. OPTIMAL-DIABETES found no comparable benefit, so evidence does not support one protocol for both conditions.
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