{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:06:12Z","timestamp":1791345972199,"version":"4.3.1"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"Importance<\/jats:title>The degree to which more intensive blood pressure reduction is better than less intensive for secondary stroke prevention has not been delineated.<\/jats:p><\/jats:sec>Objective<\/jats:title>To perform a standard meta-analysis and a meta-regression of randomized clinical trials to evaluate the association of magnitude of differential blood pressure reduction and recurrent stroke in patients with stroke or transient ischemic attack (TIA).<\/jats:p><\/jats:sec>Data Sources<\/jats:title>PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from January 1, 1980, to June 30, 2022.<\/jats:p><\/jats:sec>Study Selection<\/jats:title>Randomized clinical trials that compared more intensive vs less intensive blood pressure lowering and recorded the outcome of recurrent stroke in patients with stroke or TIA.<\/jats:p><\/jats:sec>Data Extraction and Synthesis<\/jats:title>The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA<\/jats:ext-link>) reporting guideline was used for abstracting data and assessing data quality and validity. Risk ratio (RR) with 95% CI was used as a measure of the association of more intensive vs less intensive blood pressure lowering with primary and secondary outcomes. The univariate meta-regression analyses were conducted to evaluate a possible moderating effect of magnitude of differential systolic blood pressure (SBP) and diastolic blood pressure (DBP) reduction on the recurrent stroke and major cardiovascular events.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was recurrent stroke and the lead secondary outcome was major cardiovascular events.<\/jats:p><\/jats:sec>Results<\/jats:title>Ten randomized clinical trials comprising 40\u202f710 patients (13\u202f752 women [34%]; mean age, 65 years) with stroke or TIA were included for analysis. The mean duration of follow-up was 2.8 years (range, 1-4 years). Pooled results showed that more intensive treatment compared with less intensive was associated with a reduced risk of recurrent stroke in patients with stroke or TIA (absolute risk, 8.4% vs 10.1%; RR, 0.83; 95% CI, 0.78-0.88). Meta-regression showed that the magnitude of differential SBP and DBP reduction was associated with a lower risk of recurrent stroke in patients with stroke or TIA in a log-linear fashion (SBP: regression slope, \u22120.06; 95% CI, \u22120.08 to \u22120.03; DBP: regression slope, \u22120.17; 95% CI, \u22120.26 to \u22120.08). Similar results were found in the association between differential blood pressure lowering and major cardiovascular events.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>More intensive blood pressure\u2013lowering therapy might be associated with a reduced risk of recurrent stroke and major cardiovascular events. These results might support the use of more intensive blood pressure reduction for secondary prevention in patients with stroke or TIA.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaneurol.2023.0218","type":"journal-article","created":{"date-parts":[[2023,3,20]],"date-time":"2023-03-20T15:01:01Z","timestamp":1679324461000},"page":"506","source":"Crossref","is-referenced-by-count":32,"title":["Association Between Magnitude of Differential Blood Pressure Reduction and Secondary Stroke Prevention"],"prefix":"10.1001","volume":"80","author":[{"given":"Chia-Yu","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital Chiayi Branch, Puzi, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Saver","sequence":"additional","affiliation":[{"name":"UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, Los 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