Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial
Background Stroke is associated with the development of cognitive impairment and dementia. We assessed the effect of intensive blood pressure (BP) and/or lipid lowering on cognitive outcomes in patients with recent stroke in a pilot trial. Methods In a multicentre, partial-factorial trial,...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
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Public Library of Science
2017
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| Online Access: | https://eprints.nottingham.ac.uk/44906/ |
| _version_ | 1848797025152270336 |
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| author | Bath, Philip M.W. Scutt, Polly Blackburn, Daniel J. Ankolekar, Sandeep Krishnan, Kailash Ballard, Clive Burns, Alistair Mant, Jonathan Passmore, Peter Pocock, Stuart Reckless, John Sprigg, Nikola Stewart, Rob Wardlaw, Joanna M. Ford, Gary A. |
| author_facet | Bath, Philip M.W. Scutt, Polly Blackburn, Daniel J. Ankolekar, Sandeep Krishnan, Kailash Ballard, Clive Burns, Alistair Mant, Jonathan Passmore, Peter Pocock, Stuart Reckless, John Sprigg, Nikola Stewart, Rob Wardlaw, Joanna M. Ford, Gary A. |
| author_sort | Bath, Philip M.W. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background
Stroke is associated with the development of cognitive impairment and dementia. We assessed the effect of intensive blood pressure (BP) and/or lipid lowering on cognitive outcomes in patients with recent stroke in a pilot trial.
Methods
In a multicentre, partial-factorial trial, patients with recent stroke, absence of dementia, and systolic BP (SBP) 125–170 mmHg were assigned randomly to at least 6 months of intensive (target SBP <125 mmHg) or guideline (target SBP <140 mmHg) BP lowering. The subset of patients with ischaemic stroke and total cholesterol 3.0–8.0 mmol/l were also assigned randomly to intensive (target LDL-cholesterol <1.3 mmol/l) or guideline (target LDL-c <3.0 mmol/l) lipid lowering. The primary outcome was the Addenbrooke’s Cognitive Examination-Revised (ACE-R).
Results
We enrolled 83 patients, mean age 74.0 (6.8) years, and median 4.5 months after stroke. The median follow-up was 24 months (range 1–48). Mean BP was significantly reduced with intensive compared to guideline treatment (difference –10·6/–5·5 mmHg; p<0·01), as was total/LDL-cholesterol with intensive lipid lowering compared to guideline (difference –0·54/–0·44 mmol/l; p<0·01). The ACE-R score during treatment did not differ for either treatment comparison; mean difference for BP lowering -3.6 (95% CI -9.7 to 2.4), and lipid lowering 4.4 (95% CI -2.1 to 10.9). However, intensive lipid lowering therapy was significantly associated with improved scores for ACE-R at 6 months, trail making A, modified Rankin Scale and Euro-Qol Visual Analogue Scale. There was no difference in rates of dementia or serious adverse events for either comparison.
Conclusion
In patients with recent stroke and normal cognition, intensive BP and lipid lowering were feasible and safe, but did not alter cognition over two years. The association between intensive lipid lowering and improved scores for some secondary outcomes suggests further trials are warranted. |
| first_indexed | 2025-11-14T19:57:19Z |
| format | Article |
| id | nottingham-44906 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:57:19Z |
| publishDate | 2017 |
| publisher | Public Library of Science |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-449062024-08-15T15:21:34Z https://eprints.nottingham.ac.uk/44906/ Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial Bath, Philip M.W. Scutt, Polly Blackburn, Daniel J. Ankolekar, Sandeep Krishnan, Kailash Ballard, Clive Burns, Alistair Mant, Jonathan Passmore, Peter Pocock, Stuart Reckless, John Sprigg, Nikola Stewart, Rob Wardlaw, Joanna M. Ford, Gary A. Background Stroke is associated with the development of cognitive impairment and dementia. We assessed the effect of intensive blood pressure (BP) and/or lipid lowering on cognitive outcomes in patients with recent stroke in a pilot trial. Methods In a multicentre, partial-factorial trial, patients with recent stroke, absence of dementia, and systolic BP (SBP) 125–170 mmHg were assigned randomly to at least 6 months of intensive (target SBP <125 mmHg) or guideline (target SBP <140 mmHg) BP lowering. The subset of patients with ischaemic stroke and total cholesterol 3.0–8.0 mmol/l were also assigned randomly to intensive (target LDL-cholesterol <1.3 mmol/l) or guideline (target LDL-c <3.0 mmol/l) lipid lowering. The primary outcome was the Addenbrooke’s Cognitive Examination-Revised (ACE-R). Results We enrolled 83 patients, mean age 74.0 (6.8) years, and median 4.5 months after stroke. The median follow-up was 24 months (range 1–48). Mean BP was significantly reduced with intensive compared to guideline treatment (difference –10·6/–5·5 mmHg; p<0·01), as was total/LDL-cholesterol with intensive lipid lowering compared to guideline (difference –0·54/–0·44 mmol/l; p<0·01). The ACE-R score during treatment did not differ for either treatment comparison; mean difference for BP lowering -3.6 (95% CI -9.7 to 2.4), and lipid lowering 4.4 (95% CI -2.1 to 10.9). However, intensive lipid lowering therapy was significantly associated with improved scores for ACE-R at 6 months, trail making A, modified Rankin Scale and Euro-Qol Visual Analogue Scale. There was no difference in rates of dementia or serious adverse events for either comparison. Conclusion In patients with recent stroke and normal cognition, intensive BP and lipid lowering were feasible and safe, but did not alter cognition over two years. The association between intensive lipid lowering and improved scores for some secondary outcomes suggests further trials are warranted. Public Library of Science 2017-01-17 Article PeerReviewed Bath, Philip M.W., Scutt, Polly, Blackburn, Daniel J., Ankolekar, Sandeep, Krishnan, Kailash, Ballard, Clive, Burns, Alistair, Mant, Jonathan, Passmore, Peter, Pocock, Stuart, Reckless, John, Sprigg, Nikola, Stewart, Rob, Wardlaw, Joanna M. and Ford, Gary A. (2017) Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial. PLOS ONE, 12 (1). e0164608/1-e0164608/21. ISSN 1932-6203 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164608 doi:10.1371/journal.pone.0164608 doi:10.1371/journal.pone.0164608 |
| spellingShingle | Bath, Philip M.W. Scutt, Polly Blackburn, Daniel J. Ankolekar, Sandeep Krishnan, Kailash Ballard, Clive Burns, Alistair Mant, Jonathan Passmore, Peter Pocock, Stuart Reckless, John Sprigg, Nikola Stewart, Rob Wardlaw, Joanna M. Ford, Gary A. Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial |
| title | Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial |
| title_full | Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial |
| title_fullStr | Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial |
| title_full_unstemmed | Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial |
| title_short | Intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘Prevention of decline in cognition after stroke trial’ (PODCAST) randomised controlled trial |
| title_sort | intensive versus guideline blood pressure and lipid lowering in patients with previous stroke: main results from the pilot ‘prevention of decline in cognition after stroke trial’ (podcast) randomised controlled trial |
| url | https://eprints.nottingham.ac.uk/44906/ https://eprints.nottingham.ac.uk/44906/ https://eprints.nottingham.ac.uk/44906/ |