European stroke journal · 2026
Contemporary achievement of guideline recommendations for blood pressure management after stroke in the CONVINCE trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Synnott Pádraig, Walsh Cathal, Weimar Christian, Purroy Francisco, Price Chris, Fonseca Ana Catarina, Hill Michael, Jatuzis Dalius, Kõrv Janika, Kruuse Christina, Mikulik Robert, Nederkoorn Paul, Czlonkowska Anna, Fischer Urs, Nabavi Darius G, Harbison Joseph, Cassidy Tim, O'Connor Margaret, Iversen Helle Klingenberg, Adie Katja, Lemmens Robin, Kelly Peter J, CONVINCE investigators
Аннотация
INTRODUCTION: Hypertension is a major modifiable risk factor for stroke. Studies between 1996 and 2013 reported high rates of non-achievement of guideline recommended blood pressure (BP) targets following stroke/TIA. Few recent large studies of long-term post-stroke BP management exist, and no studies have reported findings since the introduction of new guideline recommendations (systolic blood pressure [SBP] < 130 mmHg) in 2022.
PATIENTS AND METHODS: We analysed BP control in the CONVINCE trial, which randomised 3154 recent ischaemic stroke/high-risk TIA patients to colchicine 0.5 mg daily or usual care. Clinic BP was measured at 6-monthly trial visits from 2017 to 2024. We calculated mean follow-up BP using all available follow-up BP measurements, and examined factors associated with non-achievement of pre-2022 guideline BP targets by multivariable logistic regression.
RESULTS: Of 3144 randomised consenting patients, at least 1 follow-up BP reading was available for 2920. There were high rates of antiplatelet medication (97.6%) and statin (94.1%) usage. Mean SBP during follow-up was 136.6 mmHg (SD 12.8), mean diastolic BP was 79.3 mmHg (SD 7.8). A total of 36% of participants had mean SBP ≥ 140 mmHg and failed to meet pre-2022 guideline targets, while 70% had mean SBP ≥ 130 mmHg, not achieving current guideline targets. On multivariable logistic regression, increased age (OR: 1.026 per year increase; 95% CI, 1.018-1.034), history of hypertension (OR: 1.47; 95% CI, 1.24-1.74) and lacunar stroke subtype (OR: 1.26; 95% CI, 1.06-1.49) were independently associated with guideline non-achievement.
DISCUSSION AND CONCLUSION: In a large contemporary secondary stroke prevention trial, over one-third of participants did not achieve less-stringent pre-2022 BP guideline targets, and 70% did not achieve current ESO guideline targets. New approaches are needed to improve guideline implementation in practice.Trial Registration: ClinicalTrials.gov (NCT02898610).
PATIENTS AND METHODS: We analysed BP control in the CONVINCE trial, which randomised 3154 recent ischaemic stroke/high-risk TIA patients to colchicine 0.5 mg daily or usual care. Clinic BP was measured at 6-monthly trial visits from 2017 to 2024. We calculated mean follow-up BP using all available follow-up BP measurements, and examined factors associated with non-achievement of pre-2022 guideline BP targets by multivariable logistic regression.
RESULTS: Of 3144 randomised consenting patients, at least 1 follow-up BP reading was available for 2920. There were high rates of antiplatelet medication (97.6%) and statin (94.1%) usage. Mean SBP during follow-up was 136.6 mmHg (SD 12.8), mean diastolic BP was 79.3 mmHg (SD 7.8). A total of 36% of participants had mean SBP ≥ 140 mmHg and failed to meet pre-2022 guideline targets, while 70% had mean SBP ≥ 130 mmHg, not achieving current guideline targets. On multivariable logistic regression, increased age (OR: 1.026 per year increase; 95% CI, 1.018-1.034), history of hypertension (OR: 1.47; 95% CI, 1.24-1.74) and lacunar stroke subtype (OR: 1.26; 95% CI, 1.06-1.49) were independently associated with guideline non-achievement.
DISCUSSION AND CONCLUSION: In a large contemporary secondary stroke prevention trial, over one-third of participants did not achieve less-stringent pre-2022 BP guideline targets, and 70% did not achieve current ESO guideline targets. New approaches are needed to improve guideline implementation in practice.Trial Registration: ClinicalTrials.gov (NCT02898610).