Intensive Blood Pressure Control in Ischaemic Stroke Patients With Severe Cerebral Small Vessel Disease
Small Vessel Cerebrovascular Disease, Stroke
About this trial
This is an interventional treatment trial for Small Vessel Cerebrovascular Disease focused on measuring Stroke, Small Vessel Disease, Cerebral blood flow, Cognition, Elderly
Eligibility Criteria
Inclusion Criteria: Aged ≥50 Chinese ethnicity History of TIA/ischaemic stroke Underlying severe cerebral SVD as evidenced by brain MRI with total SVD score ≥3 Underlying hypertension (defined as either SBP >140mmHg and taking no more than two anti-hypertensive agents, or SBP between 130-140mmHg and on at least one and not more than three anti-hypertensive agents) Able to provide written informed consent Able to perform study cognitive assessments Modified Rankin Scale (mRS) ≤3 Expected life expectancy >2 years Exclusion Criteria: Unable to, or unwilling to consent TIA/ischaemic stroke within three months (to avoid confounding effects of recovery on cognition from recent stroke) Brain MR angiogram showing significant symptomatic or asymptomatic carotid, vertebral or intracranial large artery stenosis ≥50% as measured using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria Cortical infarction >2cm in diameter Paroxysmal or permanent atrial fibrillation Known single gene disorder causing cerebral SVD, e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) Symptomatic postural hypotension Moderate- and severe-stage dementia with Montreal Cognitive Assessment (MOCA)-HK score <10 Moderate and severe depressive symptoms with Patient Health Questionnaire-9 score ≥10 Known secondary hypertension, e.g. hypertension is due to established obstructive sleep apnoea, renal parenchymal disease, renal artery stenosis, primary aldosteronism etc. Unable to complete cognitive assessments mRS >3 Life expectancy of less than 2 years
Sites / Locations
- University of Hong KongRecruiting
Arms of the Study
Arm 1
Arm 2
Other
Other
Intensive Treatment Group
Standard Treatment Group
SBP target 120-129 mmHg
SBP target 130-140 mmHg