Allopurinol and blood pressure variability following ischemic stroke and transient ischemic attack: a secondary analysis of XILO-FIST

Alexander S. Macdonald, Alex McConnachie, David Alexander Dickie, Philip M. Bath, Kirsten Forbes, Terence Quinn, Niall M. Broomfield, Krishna Dani, Alex Doney, Keith W. Muir, Allan Struthers, Matthew Walters, Mark Barber, Ajay Bhalla, Alan Cameron, Paul Guyler, Ahamad Hassan, Mark Kearney, Breffni Keegan, Sekaran LakshmananMary Joan Macleod, Marc Randall, Louise Shaw, Ganesh Subramanian, David Werring, Jesse Dawson (Lead / Corresponding author)

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Blood Pressure Variability (BPV) is associated with cardiovascular risk and serum uric acid level. We investigated whether BPV was lowered by allopurinol and whether it was related to neuroimaging markers of cerebral small vessel disease (CSVD) and cognition. We used data from a randomised, double-blind, placebo-controlled trial of two years allopurinol treatment after recent ischemic stroke or transient ischemic attack. Visit-to-visit BPV was assessed using brachial blood pressure (BP) recordings. Short-term BPV was assessed using ambulatory BP monitoring (ABPM) performed at 4 weeks and 2 years. Brain MRI was performed at baseline and 2 years. BPV measures were compared between the allopurinol and placebo groups, and with CSVD and cognition. 409 participants (205 allopurinol; 204 placebo) were included in the visit-to-visit BPV analyses. There were no significant differences found between placebo and allopurinol groups for any measure of visit-to-visit BPV. 196 participants were included in analyses of short-term BPV at week 4. Two measures were reduced by allopurinol: the standard deviation (SD) of systolic BP (by 1.30 mmHg (95% confidence interval (CI) 0.18-2.42, p = 0.023)); and the average real variability (ARV) of systolic BP (by 1.31 mmHg (95% CI 0.31-2.32, p = 0.011)). There were no differences in other measures at week 4 or in any measure at 2 years, and BPV was not associated with CSVD or cognition. Allopurinol treatment did not affect visit-to-visit BPV in people with recent ischemic stroke or TIA. Two BPV measures were reduced at week 4 by allopurinol but not at 2 years.

Original languageEnglish
Pages (from-to)307-313
Number of pages7
JournalJournal of Human Hypertension
Issue number4
Early online date4 Mar 2024
Publication statusPublished - Apr 2024


  • Humans
  • Blood Pressure
  • Ischemic Attack, Transient/diagnostic imaging
  • Allopurinol/therapeutic use
  • Hypertension
  • Ischemic Stroke/complications
  • Uric Acid
  • Risk Factors
  • Blood Pressure Monitoring, Ambulatory


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