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 J Quinn; Niall M Broomfield; Krishna A Dani; Alex S F Doney; Keith W Muir; Allan Struthers; Matthew R Walters; Mark Barber; Ajay Bhalla; Alan Cameron; Paul Guyler; Ahamad Hassan; Mark T. Kearney; Breffni C Keegan; Lakshmanan  Sekaran; Mary Macleod; Marc Randall; Louise Shaw; Ganesh Subramanian; David J. Werring; Jesse Dawson

doi:10.1038/s41371-024-00906-5

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 J Quinn, Niall M Broomfield, Krishna A Dani, Alex S F Doney, Keith W Muir, Allan Struthers, Matthew R Walters, Mark Barber, Ajay Bhalla, Alan Cameron, Paul Guyler, Ahamad Hassan, Mark T. Kearney, Breffni C Keegan, Lakshmanan SekaranMary Macleod, Marc Randall, Louise Shaw, Ganesh Subramanian, David J. Werring, Jesse Dawson^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

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 1.30mmHg (95% confidence interval
(CI) 0.18–2.42, p=0.023)); and the average real variability (ARV) of systolic BP (by
1.31mmHg (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 language	English
Number of pages	7
Journal	Journal of Human Hypertension
Early online date	4 Mar 2024
DOIs	https://doi.org/10.1038/s41371-024-00906-5
Publication status	E-pub ahead of print - 4 Mar 2024

Bibliographical note

Acknowledgments
We would like to thank all the XILO-FIST investigators, study staff, and participants.
Funding
XILO-FIST was financially supported by a joint Stroke Association and British HeartFoundation Programme Grant (ref: TSA BHF 2013/01).

Data Availability Statement

The datasets analysed that support the findings of the present study are available from the corresponding author upon reasonable request.

Keywords

clinical trials
hypertension

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MacDonald, A. S., McConnachie, A., Dickie, D. A., Bath, P. M., Forbes, K., Quinn, T. J., Broomfield, N. M., Dani, K. A., Doney, A. S. F., Muir, K. W., Struthers, A., Walters, M. R., Barber, M., Bhalla, A., Cameron, A., Guyler, P., Hassan, A., Kearney, M. T., Keegan, B. C., ... Dawson, J. (2024). Allopurinol and Blood Pressure Variability Following Ischemic Stroke and Transient Ischemic Attack: A Secondary Analysis of XILO-FIST. Journal of Human Hypertension. Advance online publication. https://doi.org/10.1038/s41371-024-00906-5

MacDonald, AS, McConnachie, A, Dickie, DA, Bath, PM, Forbes, K, Quinn, TJ, Broomfield, NM, Dani, KA, Doney, ASF, Muir, KW, Struthers, A, Walters, MR, Barber, M, Bhalla, A, Cameron, A, Guyler, P, Hassan, A, Kearney, MT, Keegan, BC, Sekaran, L, Macleod, M, Randall, M, Shaw, L, Subramanian, G, Werring, DJ & Dawson, J 2024, 'Allopurinol and Blood Pressure Variability Following Ischemic Stroke and Transient Ischemic Attack: A Secondary Analysis of XILO-FIST', Journal of Human Hypertension. https://doi.org/10.1038/s41371-024-00906-5

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abstract = "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 1.30mmHg (95% confidence interval(CI) 0.18–2.42, p=0.023)); and the average real variability (ARV) of systolic BP (by1.31mmHg (95% CI 0.31–2.32, p=0.011)). There were no differences in othermeasures 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.",

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AU - Dickie, David Alexander

AU - Bath, Philip M

AU - Forbes, Kirsten

AU - Quinn, Terence J

AU - Broomfield, Niall M

AU - Dani, Krishna A

AU - Doney, Alex S F

AU - Muir, Keith W

AU - Struthers, Allan

AU - Walters, Matthew R

AU - Barber, Mark

AU - Bhalla, Ajay

AU - Cameron, Alan

AU - Guyler, Paul

AU - Hassan, Ahamad

AU - Kearney, Mark T.

AU - Keegan, Breffni C

AU - Sekaran, Lakshmanan

AU - Macleod, Mary

AU - Randall, Marc

AU - Shaw, Louise

AU - Subramanian, Ganesh

AU - Werring, David J.

AU - Dawson, Jesse

N1 - Acknowledgments We would like to thank all the XILO-FIST investigators, study staff, and participants. Funding XILO-FIST was financially supported by a joint Stroke Association and British HeartFoundation Programme Grant (ref: TSA BHF 2013/01).

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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 1.30mmHg (95% confidence interval(CI) 0.18–2.42, p=0.023)); and the average real variability (ARV) of systolic BP (by1.31mmHg (95% CI 0.31–2.32, p=0.011)). There were no differences in othermeasures 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.

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Allopurinol and Blood Pressure Variability Following Ischemic Stroke and Transient Ischemic Attack: A Secondary Analysis of XILO-FIST

Abstract

Bibliographical note

Data Availability Statement

Keywords

Access to Document

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