ArticleJournal of the American Geriatrics Society2015
Can blood pressure be lowered safely in older adults with lacunar stroke? The Secondary Prevention of Small Subcortical Strokes study experience.
Article in Journal of the American Geriatrics Society, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 4 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Targeting a systolic blood pressure of <130 mmHg is beneficial in adults with hypertension aged ≥75 years: a systematic review and meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Pooled it
- Is Blood Pressure Lowering in the Very Elderly With Previous Stroke Associated With a Higher Risk of Adverse Events?Journal of the American Heart Association · 2021Pooled it
- Target blood pressure level for the treatment of elderly hypertensive patients: a systematic review and meta-analysis of randomized trials.Hypertension research : official journal of the Japanese Society of Hypertension · 2019Pooled it
- Achieved systolic blood pressure in older people: a systematic review and meta-analysis.BMC geriatrics · 2017Pooled it
- The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026Article
- Re: Comment on: Optimal blood pressure target for patients with prior stroke: a systematic review and meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Article
- Hypertension in the older person: is age just a number?Internal medicine journal · 2022Review
- Targeting blood pressure for stroke prevention: current evidence and unanswered questions.Journal of neurology · 2021Review
- Cerebral Small Vessel Disease (CSVD) - Lessons From the Animal Models.Frontiers in physiology · 2019Review
- Time course of blood pressure control prior to lacunar TIA and stroke: Population-based study.Neurology · 2018Article
- Clinical Practice Guidelines. Management of Hypertension in Tunisian Adults.La Tunisie medicaleArticle
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Authors and funding
9 authors at 5 institutions in 2 countries.
Funding
Abstract
objectivesTo determine safety and tolerability of lowering blood pressure in older adults with lacunar stroke.
designCohort study.
settingThe Secondary Prevention of Small Subcortical Strokes (SPS3) Trial, which compared the efficacy of two systolic blood pressure (SBP) targets (<130 mmHg and 130-149 mmHg) for secondary stroke prevention.
participantsOf 3,020 SPS3 participants, 494 aged 75 and older at baseline were used in these analyses. MEASUREMENTS: Rates of side effects related to lowering SBP and clinical outcomes, including stroke recurrence and vascular death, were examined.
resultsOlder participants achieved SBP levels similar to those of younger participants (mean SBP of 125 mmHg and 137 mmHg in lower and higher SBP target groups, respectively). At least once during the approximately 3.5 years of follow-up, 21% reported dizziness, and 15% reported lightheadedness when standing; the only significant difference between the younger and older groups was unsteadiness when standing (23% vs 32% respectively, P < .001). There was no difference according to treatment group. In younger adults, recurrent stroke was less likely in the lower than the higher SBP group (hazard ratio (HR) = 0.77, 95% confidence interval (CI) = 0.59-1.01) but not in older participants (HR = 1.01, 95% CI = 0.59-1.73), although the interaction was not significant (P = .39). The lower SBP target was associated with a significant reduction in vascular death in older participants (HR = 0.42, 95% CI = 0.18-0.98), with a significant interaction between age and SBP group (P = .049).
conclusionExcept for unsteadiness when standing, there was no difference according to age in individuals with lacunar stroke with respect to side effects potentially related to lowering blood pressure. Although the lower SBP target was not associated with lower likelihood of recurrent stroke, these exploratory analyses suggested a possible benefit related to vascular death.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.