Overview
- OPTIMAL-STROKE, which presented results at the AHA Scientific Sessions on Saturday, found that targeting systolic blood pressure below 120 mm Hg reduced the risk of a composite of cardiovascular death, nonfatal heart attack, nonfatal stroke, or hospitalization compared with a target below 140 mm Hg.
- The randomized trial enrolled 4,368 adults at 30 sites in Brazil and, over a median 3.9 years of follow-up, achieved mean systolic BPs of about 122 mm Hg in the intensive arm versus 135.2 mm Hg in the standard arm with a hazard ratio of 0.79 for the primary outcome.
- Intensive treatment produced more renal events (3.9% versus 2.2%), which investigators said reflected sustained drops in kidney function likely from hemodynamic effects, but there was no increase in dialysis, end-stage kidney disease, or renal mortality.
- Overall rates of serious adverse events were similar between groups, and investigators and outside experts said the data reduce previous concerns about harming brain perfusion after stroke while stressing that lower targets will require careful monitoring and coordination among neurologists, primary care clinicians, and nephrologists.
- Related findings presented at the meeting included a neutral result from OPTIMAL-DIABETES on the same lower target in people with type 2 diabetes and a smaller REDUCE trial that showed early spironolactone helped more patients reach a <130/80 mm Hg goal at three months, underscoring that optimal post-stroke blood-pressure strategies may vary by population.