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

TY - JOUR

T1 - Allopurinol and blood pressure variability following ischemic stroke and transient ischemic attack

T2 - a secondary analysis of XILO-FIST

AU - Macdonald, Alexander S.

AU - McConnachie, Alex

AU - Dickie, David Alexander

AU - Bath, Philip M.

AU - Forbes, Kirsten

AU - Quinn, Terence

AU - Broomfield, Niall M.

AU - Dani, Krishna

AU - Doney, Alex

AU - Muir, Keith W.

AU - Struthers, Allan

AU - Walters, Matthew

AU - Barber, Mark

AU - Bhalla, Ajay

AU - Cameron, Alan

AU - Guyler, Paul

AU - Hassan, Ahamad

AU - Kearney, Mark

AU - Keegan, Breffni

AU - Lakshmanan, Sekaran

AU - Macleod, Mary Joan

AU - Randall, Marc

AU - Shaw, Louise

AU - Subramanian, Ganesh

AU - Werring, David

AU - Dawson, Jesse

N1 - © 2024. The Author(s).

PY - 2024/4

Y1 - 2024/4

N2 - 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.

AB - 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.

KW - Humans

KW - Blood Pressure

KW - Ischemic Attack, Transient/diagnostic imaging

KW - Allopurinol/therapeutic use

KW - Hypertension

KW - Ischemic Stroke/complications

KW - Uric Acid

KW - Risk Factors

KW - Blood Pressure Monitoring, Ambulatory

UR - https://www.scopus.com/pages/publications/85186593279

U2 - 10.1038/s41371-024-00906-5

DO - 10.1038/s41371-024-00906-5

M3 - Article

C2 - 38438602

SN - 0950-9240

VL - 38

SP - 307

EP - 313

JO - Journal of Human Hypertension

JF - Journal of Human Hypertension

IS - 4

ER -