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A total of 1074 patients with a history of ischemic stroke enrolled in The Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study were assigned to intensive blood pressure (BP) control group (blood pressure < 120/80 mmHg) or standard blood pressure control group (blood pressure < 140/90 mmHg) and were followed up for a mean of 3.9 years. Seventy-eight first recurrent strokes occurred, including 70 ischemic stroke and 8 intracerebral hemorrhage. Intensive treatment did not change annual risk of ischemic stroke (1.74% vs. 1.75%, P = 0.999), but markedly reduced risk of hemorrhagic stroke (0.00% vs. 0.39%, P = 0.005). Beneficial effect of intensive BP control were observed for risk of hemorrhagic stroke in the patients with a history of ischemic stroke.
Xanthine oxidase (XO) inhibition by febuxostat, rather than the effect of lowering hyperuricemia, may have directly contributed to the improvement of arterial stiffness in the present study. Plausible explanations of this beneficial effect are proposed as the counter action via XO inhibition to macrophage adventitial infiltration, vascular cell hypertrophy, and proliferation of vascular smooth muscle cell and vascular wall connective tissues or endothelial dysfunction.