OBJECTIVE\nTo assess whether using intensive blood pressure\ntargets leads to lower blood pressure in a community\npopulation of people with prevalent cerebrovascular\ndisease.\nDESIGN\nOpen label randomised controlled trial.\nSETTING\n99 general practices in England, with participants\nrecruited in 2009-11.\nPARTICIPANTS\nPeople with a history of stroke or transient ischaemic\nattack whose systolic blood pressure was 125 mm Hg\nor above.\nINTERVENTIONS\nIntensive systolic blood pressure target (<130 mm Hg\nor 10 mm Hg reduction from baseline if this was <140\nmm Hg) or standard target (<140 mm Hg). Apart from\nthe different target, patients in both arms were actively\nmanaged in the same way with regular reviews by the\nprimary care team.\nMAIN OUTCOME MEASURE\nChange in systolic blood pressure between baseline\nand 12 months.\nRESULTS\n529 patients (mean age 72) were enrolled, 266 to the\nintensive target arm and 263 to the standard target\narm, of whom 379 were included in the primary analysis\n(182 (68%) intensive arm; 197 (75%) standard arm). 84\npatients withdrew from the study during the follow-up\nperiod (52 intensive arm; 32 standard arm). Mean\nsystolic blood pressure dropped by 16.1 mm Hg to 127.4\nmm Hg in the intensive target arm and by 12.8 mm Hg to\n129.4 mm Hg in the standard arm (difference between\ngroups 2.9 (95% confidence interval 0.2 to 5.7) mm Hg;\nP=0.03).\nCONCLUSIONS\nAiming for target below 130 mm Hg rather than 140 mm\nHg for systolic blood pressure in people with\ncerebrovascular disease in primary care led to a small\nadditional reduction in blood pressure. Active\nmanagement of systolic blood pressure in this\npopulation using a <140 mm Hg target led to a\nclinically important reduction in blood pressure.\nTRIAL REGISTRATION\nCurrent Controlled Trials ISRCTN29062286.
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