{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:58:12Z","timestamp":1791428292428,"version":"4.3.3"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,8,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We conducted a post hoc analysis of the SPS3 (Secondary Prevention of Small Subcortical Strokes) Trial to examine the association of chronic kidney disease (\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              ) with\n              <jats:italic>recurrent<\/jats:italic>\n              stroke, and to assess whether baseline renal function modifies the effects of intensive systolic blood pressure control in patients with previous stroke.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A total of 3020 patients with recent magnetic resonance imaging\u2013defined symptomatic lacunar infarctions were randomized to a systolic blood pressure target of &lt;130\u00a0mm\u00a0Hg versus 130 to 149\u00a0mm\u00a0Hg. Predefined primary outcomes were (all\u2010recurrent) stroke and a composite of stroke, acute myocardial infarction, or all\u2010cause death; secondary outcomes were acute myocardial infarction, all\u2010cause death, and intracerebral hemorrhage individually. Among 3017 patients with baseline estimated glomerular filtration rate measurements, we evaluated, using Cox proportional hazards models, the association of\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              with recurrent stroke and effects of the blood pressure targets on outcomes using baseline estimated glomerular filtration rate both as a categorical and linear variable. Regardless of the randomized treatment,\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              at baseline was significantly associated with an increased risk of the primary cardiovascular composite outcome (hazard ratio, 1.7; 95% CI, 1.4\u20132.1), and all\u2010recurrent stroke (1.5; 1.1\u20132.0). However, the effects of the lower systolic blood pressure intervention on the primary outcome were not influenced by baseline\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              status (\n              <jats:italic>P<\/jats:italic>\n              for interaction=0.62).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              increases the risk of recurrent stroke by 50% in patients with previous lacunar stroke. We found no definitive evidence that renal dysfunction modifies the effects of systolic blood pressure control in patients with previous stroke. Conclusive evidence for this will require adequately powered studies with moderate\u2010to\u2010advanced\n              <jats:styled-content style=\"fixed-case\">CKD<\/jats:styled-content>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Clinical Trial Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              <jats:styled-content style=\"fixed-case\">URL<\/jats:styled-content>\n              :\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier:\n              <jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>\n              00059306.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.013098","type":"journal-article","created":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T09:12:07Z","timestamp":1566205927000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Effect of Baseline Kidney Function on the Risk of Recurrent Stroke and on Effects of Intensive Blood Pressure Control in Patients With Previous Lacunar Stroke: A Post Hoc Analysis of the SPS3 Trial (Secondary Prevention of Small Subcortical Strokes)"],"prefix":"10.1161","volume":"8","author":[{"given":"Adhish","family":"Agarwal","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension University of Utah Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred K.","family":"Cheung","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension University of Utah Salt Lake City UT"},{"name":"Renal Section VA Salt Lake City Health Care System Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianing","family":"Ma","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension University of Utah Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension University of Utah Salt Lake City UT"},{"name":"Renal Section VA Salt Lake City Health Care System Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension University of Utah Salt Lake City UT"},{"name":"VA Boston Healthcare System VA Cooperative Studies Program Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2010.00573.x"},{"key":"e_1_3_2_3_2","first-page":"507","article-title":"Blood\u2010pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial","author":"Benavente OR","year":"2013","unstructured":"Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, Pearce LA, Pergola PE, Szychowski JM. 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