Effect of blood pressure-lowering agents on microvascular function in people with small vessel diseases (TREAT-SVDs): a multicentre, open-label, randomised, crossover trial
In RCT (n=101), 4 weeks of treatment with amlodipine, losartan, or atenolol did not differ in their effects on microvascular function, but in patients with CADASIL, cerebrovascular reactivity improved with both amlodipine and losartan compared with atenolol.
Source:
The Lancet Neurology
SPS commentary:
The study included 62 patients with sporadic cerebral small vessel disease and 17 with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). Findings are limited as it was terminated prematurely for participants with CADASIL because of slow recruitment, and overall sample size was small. In addition, the proportion of participants with incomplete datasets for the primary outcome was relatively high, treatment period for each drug was short, and results cannot be generalised to all people with small vessel disease and hypertension because of range of exclusion criteria.
A commentary notes that cerebral small vessel disease is common and accounts for up to 30% of strokes and plays a part in about 40% of dementia cases, yet proven prevention strategies and treatments are scarce. It also points out that because of the small sample size, caution is needed in relation to interpretation of the results. It suggests that unless there is a comorbid condition or compelling indication for a β blocker, a reasonable approach for patients with symptomatic cerebral small vessel disease would be to consider administration of a calcium channel blocker or an angiotensin receptor blocker while future study results are awaited.