Abstract 95: The impact of Blood Pressure Variability on Stroke Recurrence: The SPS3 trial
Bibliographic record
Abstract
Background: Blood pressure variability (BPV) has been identified as an independent and powerful risk factor for first and recurrent stroke. However, the role of visit-to-visit BPV in stroke patients with well-controlled blood pressure is not well defined. Methods: Participants from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial were included. All participants had recent symptomatic MRI-proven lacunar infarcts. Visit-to-visit BPV was defined by average real variability (ARV; mean absolute difference from visit to visit), standard deviation (SD) and coefficient of variation (CV; equal to SD/mean). We analyzed the association between BPV and recurrence of stroke, myocardial infarction and death. Results: There were 2666 participants included in the analysis with a mean of 13.7 followup visits per patient (36498 visits overall). Mean age was 63 y and 63% were male. Mean blood pressure was 132/72 and ARV was 12/7 mm Hg. There was no relationship between systolic or diastolic BPV and all recurrent stroke, nor was there a relationship between BPV and recurrent ischemic stroke or hemorrhagic stroke. After multivariable adjustment, increased systolic BPV was associated with all-cause mortality (HR 1.05 per mm Hg, 95% CI 1.03-1.08, p=0.0001) and MI (HR 1.05, 95% CI 1.01-1.97, p=0.02). There was a weak but significant correlation between systolic and diastolic ARV and average number of antihypertensive medications during the trial (systolic Spearman rank 0.214, p<0.0001, diastolic 0.135, p<0.0001). However, there was no relationship between ARV and stroke, regardless of the number of antihypertensives a patient was taking one year after randomization. Conclusion: In this well-characterized population with symptomatic lacunar stroke and well-controlled blood pressure, visit-to-visit BPV was not associated with stroke recurrence. The directionality and nature of the relationship between BPV, MI and death is not well understood and requires further investigation. The lack of an association between BPV and stroke may have been precluded by aggressive and dynamic BP management in this cohort.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".