Eur Stroke J. 2026 Jul 6;11(7):aakag051. doi: 10.1093/esj/aakag051.
ABSTRACT
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).
PMID:42418305 | DOI:10.1093/esj/aakag051