Evidence map›Paper›PMID 26553236›Full record

Trial reportHypertension (Dallas, Tex. : 1979)2016

Achieved Blood Pressure and Outcomes in the Secondary Prevention of Small Subcortical Strokes Trial.

Michelle C Odden, Leslie A McClure, B Peter Sawaya, Carole L White, Carmen A Peralta, Thalia S Field, Robert G Hart, Oscar R Benavente, Pablo E Pergola

Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Hypertension (Dallas, Tex. : 1979), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00059306 (Secondary Prevention of Small Subcortical Strokes), which is not on this map. Cited by 19 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 3 pooled it
6.5field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

NCT00059306 phase3completednot on this map

Secondary Prevention of Small Subcortical Strokes (SPS3) Trial

TypeinterventionalSponsorUniversity of British ColumbiaRan2003 to 2012Enrolled3,020ConditionsCerebrovascular Accident, HypertensionArmsaspirin, clopidogrel, Target of Blood Pressure, placebo
3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 71 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
  4. Trial
  5. Trial
  6. Article
  7. Blood pressure management for secondary stroke prevention.Hypertension research : official journal of the Japanese Society of Hypertension · 2022
    Review
  8. Article
  9. Review
  10. Article
  11. To whom recommend intensive treatment for hypertension?European heart journal supplements : journal of the European Society of Cardiology · 2020
    Article
  12. Article
  13. Article
  14. Review
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 2 countries.

Michelle C OddenFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.). Michelle.Odden@oregonstate.edu.
Leslie A McClureFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
B Peter SawayaFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
Carole L WhiteFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
Carmen A PeraltaFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
Thalia S FieldFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
Robert G HartFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
Oscar R BenaventeFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
Pablo E PergolaFrom the School of Biological and Population Health Sciences, Oregon State University, Corvallis (M.C.O.); Department of Biostatistics, University of Alabama at Birmingham (L.A.M.); Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington (B.P.S.); Department of Health Restoration and Care Systems Management, School of Nursing, University of Texas Health Science Center, San Antonio (C.L.W.); Department of Medicine, University of California, San Francisco (C.A.P.); Center for Brain Health, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.); Population Health Research Institute, Hamilton, CA (R.G.H.); and Renal Associates PA, San Antonio, TX (P.E.P.).
University of Kentucky · USUniversity of Alabama at Birmingham · USUniversity of British Columbia · CAUniversity of California, San Francisco · US

Funding

SECONDARY PREVENTION OF SMALL SUBCORTICAL STROKES (SPSS)U01NS038529 · NINDS · UNIVERSITY OF TEXAS HLTH SCIENCE CENTER · PI BENAVENTE, OSCAR R · 2003 to 2012
$62.9M
VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Alexander Keliimoeanu Smith · 2013 to 2026
$19.9M
A New Paradigm for Hypertension in the Elderly- Beyond AgeR01AG046206 · NIA · NORTHERN CALIFORNIA INSTITUTE/RES/EDU · PI ODDEN, MICHELLE CHRISTINA, PERALTA, CARMEN ALICIA · 2014 to 2018
$1.4M
Modeling Optimal Strategies to Prevent Cardiovascular Events in Older AdultsK01AG039387 · NIA · OREGON STATE UNIVERSITY · PI ODDEN, MICHELLE CHRISTINA · 2012 to 2016
$688k
NIA NIH HHS K01 AG039387NIA NIH HHS K01AG039387NIA NIH HHS P30 AG044281NIA NIH HHS R01 AG046206NIA NIH HHS R01AG46206NINDS NIH HHS U01 NS038529NINDS NIH HHS U01NS038529
6 · The paper itself

Abstract

unlabelledStudies suggest a J-shaped association between blood pressure and cardiovascular events in the setting of intensive systolic blood pressure control; whether there is a similar association with stroke remains less well established. The Secondary Prevention of Small Subcortical Strokes was a randomized trial to evaluate higher (130-149 mm Hg) versus lower (<130 mm Hg) systolic blood pressure targets in participants with recent lacunar infarcts. We evaluated the association of mean achieved blood pressure, 6 months after randomization, and recurrent stroke, major vascular events, and all-cause mortality. After a mean follow up of 3.7 years, there was a J-shaped association between achieved blood pressure and outcomes; the lowest risk was at ≈124 and 67 mm Hg systolic and diastolic blood pressure, respectively. For example, above a systolic blood pressure of 124 mm Hg, 1 standard deviation higher (11.1 mm Hg) was associated with increased mortality (adjusted hazard ratio: 1.9; 95% confidence interval: 1.4, 2.7), whereas below this level, this relationship was inverted (0.29; 0.10, 0.79), P<0.001 for interaction. Above a diastolic blood pressure of 67 mm Hg, a 1 standard deviation higher (8.2 mm Hg) was associated with an increased risk of stroke (2.2; 1.4, 3.6), whereas below this level, the association was in the opposite direction (0.34; 0.13, 0.89), P=0.02 for interaction. The lowest risk of all events occurred at a nadir of ≈120 to 128 mm Hg systolic blood pressure and 65 to 70 mm Hg diastolic blood pressure. Future studies should evaluate the impact of excessive blood pressure reduction, especially in older populations with preexisting vascular disease. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00059306.

Indexed as

AspirinBlood PressureBlood Pressure DeterminationClopidogrelDrug Therapy, CombinationFemaleHumansHypertensionMagnetic Resonance ImagingMaleMiddle AgedPlatelet Aggregation InhibitorsRecurrenceSecondary PreventionSeverity of Illness IndexStroke, LacunarAspirinClopidogrelPlatelet Aggregation InhibitorsTiclopidineagedantihypertensive agentsblood pressuresecondary preventionstroke

Identifiers

PMID26553236
PMCPMC4679688
OpenAlexW2114088386

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

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.