Cerebral White Matter Hyperintensities, Kidney Function Decline, and Recurrent Stroke After Intensive Blood Pressure Lowering: Results From the Secondary Prevention of Small Subcortical Strokes ( SPS 3) Trial.

Background- — We aimed to determine whether cerebral white matter hyperintensities (WMHs) can distinguish stroke survivors susceptible to rapid kidney function decline from intensive blood pressure (BP) lowering. Methods and Results- — The SPS3 (Secondary Prevention of Small Subcortical Strokes) trial randomized participants with recent lacunar stroke to systolic BP targets of 130 to 149 and < 130 mm Hg. We included 2454 participants with WMH measured by clinical magnetic resonance imaging at baseline and serum creatinine measured during follow-up. We tested interactions between BP target and WMH burden on the incidence of rapid kidney function decline ( ≥ 30% decrease from baseline estimated glomerular fi ltration rate at 1-year follow-up) and recurrent stroke. Rapid kidney function decline incidence was 11.0% in the lower-BP-target arm and 8.1% in the higher-target arm (odds ratio = 1.40; 95% CI = 1.07 – 1.84). Odds ratio for rapid kidney function decline between lower- and higher-target groups ranged from 1.26 in the lowest WMH tertile (95% CI, 0.80 – 1.98) to 1.71 in the highest tertile (95% CI, 1.05 – 2.80; P for interaction = 0.65). Overall incidence of recurrent stroke was 7.9% in the lower-target arm and 9.6% in the higher-target arm (hazard ratio = 0.80; 95% CI, 0.63 – 1.03). Hazard ratio for recurrent stroke in the lower-target group was 1.13 (95% CI, 0.73 – 1.75) within the lowest WMH tertile compared with 0.73 (95% CI,

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