Recurrence of lacunar stroke and blood pressure control. Kanagawa REALITY

Information on the background and status of recurrence realities of lacunar infarction (LI) is still limited. We investigated 856 patients started to treat from 1997 to 2000, in whom a diagnosis of first-ever symptomatic LI was detected by MRI were enrolled, excluding possible cardiogenic embolic stroke or branch atheromatous disease using medical records in 14 institutions in Kanagawa, retrospectively. Recurrent cerebrovascular events (CVEs) occurred in 96 patients (11%) and the annual incidence was 4.8%. The mean systolic blood pressure (SBP) just before recurrence of CVEs was significantly higher than the mean SBP at final follow-up in recurrence-free patients (P<0.001). As the result of multivariate analysis performed after adjusting for following risk factors, antiplatelet therapy, a high SBP just before the end of follow-up, the presence of diabetes mellitus, and a modified Rankin scale≥5 were independent prognostic factors related to recurrence of CVEs. The recurrence rates of CVEs or LI were decreased by lowering of the SBP and diastolic blood pressure (DBP) just before the end of follow-up. Our analyses provide no evidence of a J-curve relationship between BP level and a recurrence after first-ever symptomatic LI. (author)