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Effect of Standard vs Intensive Blood Pressure Control on Cerebral Blood Flow in Small Vessel Disease: The PRESERVE Randomized Clinical Trial.

Croall, ID; Tozer, DJ; Moynihan, B; Khan, U; O'Brien, JT; Morris, RG; Cambridge, VC; Barrick, TR; Blamire, AM; Ford, GA; et al. Croall, ID; Tozer, DJ; Moynihan, B; Khan, U; O'Brien, JT; Morris, RG; Cambridge, VC; Barrick, TR; Blamire, AM; Ford, GA; Markus, HS; PRESERVE Study Team (2018) Effect of Standard vs Intensive Blood Pressure Control on Cerebral Blood Flow in Small Vessel Disease: The PRESERVE Randomized Clinical Trial. JAMA Neurol, 75 (6). pp. 720-727. ISSN 2168-6157 https://doi.org/10.1001/jamaneurol.2017.5153
SGUL Authors: Barrick, Thomas Richard

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Abstract

Importance: Blood pressure (BP) lowering is considered neuroprotective in patients with cerebral small vessel disease; however, more intensive regimens may increase cerebral hypoperfusion. This study examined the effect of standard vs intensive BP treatment on cerebral perfusion in patients with severe small vessel disease. Objective: To investigate whether standard vs intensive BP lowering over 3 months causes decreased cerebral perfusion in small vessel disease. Design, Setting, and Participants: This randomized clinical trial took place at 2 English university medical centers. Patients were randomized via a central online system (in a 1:1 ratio). Seventy patients with hypertension and with magnetic resonance imaging-confirmed symptomatic lacunar infarct and confluent white matter hyperintensities were recruited between February 29, 2012, and October 21, 2015, and randomized (36 in the standard group and 34 in the intensive group). Analyzable data were available in 62 patients, 33 in the standard group and 29 in the intensive group, for intent-to-treat analysis. This experiment examines the 3-month follow-up period. Interventions: Patients were randomized to standard (systolic, 130-140 mm Hg) or intensive (systolic, <125 mm Hg) BP targets, to be achieved through medication changes. Main Outcomes and Measures: Cerebral perfusion was measured using arterial spin labeling; the primary end point was change in global perfusion between baseline and 3 months, compared between treatment groups by analysis of variance. Linear regression compared change in perfusion against change in BP. Magnetic resonance imaging scan analysis was masked to treatment group. Results: Among 62 analyzable patients, the mean age was 69.3 years, and 60% (n = 37) were male. The mean (SD) systolic BP decreased by 8 (12) mm Hg in the standard group and by 27 (17) mm Hg in the intensive group (P < .001), with mean (SD) achieved pressures of 141 (13) and 126 (10) mm Hg, respectively. Change in global perfusion did not differ between treatment groups: the mean (SD) change was -0.5 (9.4) mL/min/100 g in the standard group vs 0.7 (8.6) mL/min/100 g in the intensive group (partial η2, 0.004; 95% CI, -3.551 to 5.818; P = .63). No differences were observed when the analysis examined gray or white matter only or was confined to those achieving target BP. The number of adverse events did not differ between treatment groups, with a mean (SD) of 0.21 (0.65) for the standard group and 0.32 (0.75) for the intensive group (P = .44). Conclusions and Relevance: Intensive BP lowering did not reduce cerebral perfusion in severe small vessel disease. Trial Registration: isrctn.org Identifier: ISRCTN37694103.

Item Type: Article
Additional Information: This is an open access article distributed under the terms of the CC-BY License (https://jamanetwork.com/journals/jamaneurology/pages/instructions-for-authors#SecOpenAccess/). © 2018 Croall ID et al. JAMA Neurology.
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: JAMA Neurol
ISSN: 2168-6157
Language: eng
Dates:
DateEvent
June 2018Published
5 March 2018Published Online
8 December 2017Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
TSA BHF 2010/01British Heart Foundationhttp://dx.doi.org/10.13039/501100000274
TSA BHF 2010/01Stroke Associationhttp://dx.doi.org/10.13039/501100000364
PubMed ID: 29507944
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109714
Publisher's version: https://doi.org/10.1001/jamaneurol.2017.5153

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