Aggressive Medical Management Improves Racial Disparities in Vascular Risk Factors

Aggressive medical management can improve disparities in risk factor control in Black and non-Black patients, according to a study published on Stroke.    

In the original Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial (SAMMPRIS; ClinicalTrials.gov Identifier: NCT00576693), a randomized controlled trial conducted between 2008 and 2011, researchers compared aggressive medical management vs aggressive medical management plus percutaneous transluminal angioplasty and stenting (PTAS) in patients with severe symptomatic intracranial atherosclerotic stenosis and found that aggressive medical management was superior to PTAS.

In this post-hoc analysis, researchers assessed whether aggressive medical management amended disparities in vascular risk factors control between Black and non-Black patients.

A total of 104 Black patients and 347 non-Black patients were enrolled in the SAMMPRIS trial with complete risk factor data. For this exploratory outcome analysis, the primary end point — stroke or death within 30 days after enrollment or ischemic stroke between day 31 and the end of the follow-up period — was compared between Black and non-Black patients. Vascular factors analyzed at baseline and 1 year included blood pressure, low-density lipoprotein (LDL) cholesterol levels, high-density lipoprotein (HDL) cholesterol levels, hemoglobin A_1C (HbA_1C), physical activity, and medication.

Researchers found a higher number of stroke or death among Black patients compared with non-Black patients (n, 49 vs 178) who received aggressive medical management arm during 3 years of follow up (1 year, 14.6% vs 12.1%; 2 years, 19.0% vs 12.7%; 3 years, 22.8% vs 12.7%, respectively); however, there was no statistically significant difference (P =.28).

At baseline, significant differences between Black and non-Black patients included:

• History of hypertension: 95.2% vs 87.5%, respectively; P =.027
• History of diabetes: 52.9% vs 39.7%, respectively; P =.017
• Mean diastolic blood pressure (DBP): 82.4 mmHg vs 79.5 mmHg, respectively; P=.035
• Mean HDL: 41.2 mg/dL vs 38 mg/dL, respectively; P=.008
• Baseline PACE scores: 2.7 vs 3.3, respectively; P =.002

Compared with non-Black patients, Black patients were more likely to be prescribed diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers. There were no significant differences were found in mean systolic BP (SBP; P =.301) and LDL (P =.135) .

After 1 year, there was no longer a baseline disparity in DBP and PACE scores between Black and non-Black patients and still no significant differences in mean SBP, LDL, or HbA_1C. Notably, Black patients used more diuretics after receiving aggressive medical management.  

Key limitation includes the low power for the primary end point analysis due to the small sample size.

“[A] unique finding of this analysis is that after 1 year of AMM [aggressive medical management], the differences in DBP and physical activity score between Black and non-Black patients were no longer present,” the researchers conclude, and “protocol-driven intensive risk factor management may have an important role in ameliorating disparities in risk factor control between Black and non-Black subjects.”