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Degree of blood pressure reduction and recurrent stroke: the PROGRESS trial

Objective There is ongoing controversy regarding a ‘J-curve’ phenomenon such that low and high blood pressure (BP) levels are associated with increased risks of recurrent stroke. We aimed to determine whether large treatment-related BP reductions are associated with increased risks of recurrent stro... Full description

Journal Title: Journal of neurology neurosurgery and psychiatry, 2014-11, Vol.85 (11), p.1284-1285
Main Author: Arima, Hisatomi
Other Authors: Anderson, Craig , Omae, Teruo , Woodward, Mark , MacMahon, Stephen , Mancia, Giuseppe , Bousser, Marie-Germaine , Tzourio, Christophe , Harrap, Stephen , Liu, Lisheng , Neal, Bruce , Chalmers, John
Format: Electronic Article Electronic Article
Language: English
Subjects:
Antihypertensive Agents - therapeutic use
Blood Pressure - physiology
Female
Health risk assessment
Humans
Hypertension - complications
Hypertension - drug therapy
Male
Middle Aged
Perindopril - therapeutic use
Prevention
Recurrence
Risk Factors
Stroke
Stroke (Disease)
Stroke - etiology
Stroke - physiopathology
Veins & arteries
Publisher: England: BMJ Publishing Group Ltd
ID: ISSN: 0022-3050
Link: https://www.ncbi.nlm.nih.gov/pubmed/24828894
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title: Degree of blood pressure reduction and recurrent stroke: the PROGRESS trial
format: Article
creator:
  • Arima, Hisatomi
  • Anderson, Craig
  • Omae, Teruo
  • Woodward, Mark
  • MacMahon, Stephen
  • Mancia, Giuseppe
  • Bousser, Marie-Germaine
  • Tzourio, Christophe
  • Harrap, Stephen
  • Liu, Lisheng
  • Neal, Bruce
  • Chalmers, John
subjects:
  • Antihypertensive Agents - therapeutic use
  • Blood Pressure - physiology
  • Female
  • Health risk assessment
  • Humans
  • Hypertension - complications
  • Hypertension - drug therapy
  • Male
  • Middle Aged
  • Perindopril - therapeutic use
  • Prevention
  • Recurrence
  • Risk Factors
  • Stroke
  • Stroke (Disease)
  • Stroke - etiology
  • Stroke - physiopathology
  • Veins & arteries
ispartof: Journal of neurology, neurosurgery and psychiatry, 2014-11, Vol.85 (11), p.1284-1285
description: Objective There is ongoing controversy regarding a ‘J-curve’ phenomenon such that low and high blood pressure (BP) levels are associated with increased risks of recurrent stroke. We aimed to determine whether large treatment-related BP reductions are associated with increased risks of recurrent stroke. Design Data are from the PROGRESS trial, where 6105 patients with cerebrovascular disease were randomly assigned to either active treatment (perindopril±indapamide) or placebo(s). There were no BP criteria for entry. BP was measured at every visit, and participant groups defined by reduction in systolic BP (SBP) from baseline were used for the analyses. Outcome was recurrent stroke. Results During a mean follow-up of 3.9 years, 727 recurrent strokes were observed. There were clear associations between the magnitude of SBP reduction and the risk of recurrent stroke. After adjustment for cardiovascular risk factors and randomised treatment, annual incidence was 2.08%, 2.10%, 2.31% and 2.96% for participant groups defined by SBP reductions of ≥20, 10–19, 0–9 and
language: eng
source:
identifier: ISSN: 0022-3050
fulltext: no_fulltext
issn:
  • 0022-3050
  • 1468-330X
url: Link


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titleDegree of blood pressure reduction and recurrent stroke: the PROGRESS trial
creatorArima, Hisatomi ; Anderson, Craig ; Omae, Teruo ; Woodward, Mark ; MacMahon, Stephen ; Mancia, Giuseppe ; Bousser, Marie-Germaine ; Tzourio, Christophe ; Harrap, Stephen ; Liu, Lisheng ; Neal, Bruce ; Chalmers, John
creatorcontribArima, Hisatomi ; Anderson, Craig ; Omae, Teruo ; Woodward, Mark ; MacMahon, Stephen ; Mancia, Giuseppe ; Bousser, Marie-Germaine ; Tzourio, Christophe ; Harrap, Stephen ; Liu, Lisheng ; Neal, Bruce ; Chalmers, John ; PROGRESS Collaborative Group ; for the PROGRESS Collaborative Group
descriptionObjective There is ongoing controversy regarding a ‘J-curve’ phenomenon such that low and high blood pressure (BP) levels are associated with increased risks of recurrent stroke. We aimed to determine whether large treatment-related BP reductions are associated with increased risks of recurrent stroke. Design Data are from the PROGRESS trial, where 6105 patients with cerebrovascular disease were randomly assigned to either active treatment (perindopril±indapamide) or placebo(s). There were no BP criteria for entry. BP was measured at every visit, and participant groups defined by reduction in systolic BP (SBP) from baseline were used for the analyses. Outcome was recurrent stroke. Results During a mean follow-up of 3.9 years, 727 recurrent strokes were observed. There were clear associations between the magnitude of SBP reduction and the risk of recurrent stroke. After adjustment for cardiovascular risk factors and randomised treatment, annual incidence was 2.08%, 2.10%, 2.31% and 2.96% for participant groups defined by SBP reductions of ≥20, 10–19, 0–9 and <0 mm Hg, respectively (p=0.0006 for trend). Conclusions The present analysis provided no evidence of an increase in recurrent stroke associated with larger reductions in SBP produced by treatment among patients with cerebrovascular disease.
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subjectAntihypertensive Agents - therapeutic use ; Blood Pressure - physiology ; Female ; Health risk assessment ; Humans ; Hypertension - complications ; Hypertension - drug therapy ; Male ; Middle Aged ; Perindopril - therapeutic use ; Prevention ; Recurrence ; Risk Factors ; Stroke ; Stroke (Disease) ; Stroke - etiology ; Stroke - physiopathology ; Veins & arteries
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0Degree of blood pressure reduction and recurrent stroke: the PROGRESS trial
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descriptionObjective There is ongoing controversy regarding a ‘J-curve’ phenomenon such that low and high blood pressure (BP) levels are associated with increased risks of recurrent stroke. We aimed to determine whether large treatment-related BP reductions are associated with increased risks of recurrent stroke. Design Data are from the PROGRESS trial, where 6105 patients with cerebrovascular disease were randomly assigned to either active treatment (perindopril±indapamide) or placebo(s). There were no BP criteria for entry. BP was measured at every visit, and participant groups defined by reduction in systolic BP (SBP) from baseline were used for the analyses. Outcome was recurrent stroke. Results During a mean follow-up of 3.9 years, 727 recurrent strokes were observed. There were clear associations between the magnitude of SBP reduction and the risk of recurrent stroke. After adjustment for cardiovascular risk factors and randomised treatment, annual incidence was 2.08%, 2.10%, 2.31% and 2.96% for participant groups defined by SBP reductions of ≥20, 10–19, 0–9 and <0 mm Hg, respectively (p=0.0006 for trend). Conclusions The present analysis provided no evidence of an increase in recurrent stroke associated with larger reductions in SBP produced by treatment among patients with cerebrovascular disease.
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titleDegree of blood pressure reduction and recurrent stroke: the PROGRESS trial
authorArima, Hisatomi ; Anderson, Craig ; Omae, Teruo ; Woodward, Mark ; MacMahon, Stephen ; Mancia, Giuseppe ; Bousser, Marie-Germaine ; Tzourio, Christophe ; Harrap, Stephen ; Liu, Lisheng ; Neal, Bruce ; Chalmers, John
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5Hypertension - complications
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7Male
8Middle Aged
9Perindopril - therapeutic use
10Prevention
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12Risk Factors
13Stroke
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abstractObjective There is ongoing controversy regarding a ‘J-curve’ phenomenon such that low and high blood pressure (BP) levels are associated with increased risks of recurrent stroke. We aimed to determine whether large treatment-related BP reductions are associated with increased risks of recurrent stroke. Design Data are from the PROGRESS trial, where 6105 patients with cerebrovascular disease were randomly assigned to either active treatment (perindopril±indapamide) or placebo(s). There were no BP criteria for entry. BP was measured at every visit, and participant groups defined by reduction in systolic BP (SBP) from baseline were used for the analyses. Outcome was recurrent stroke. Results During a mean follow-up of 3.9 years, 727 recurrent strokes were observed. There were clear associations between the magnitude of SBP reduction and the risk of recurrent stroke. After adjustment for cardiovascular risk factors and randomised treatment, annual incidence was 2.08%, 2.10%, 2.31% and 2.96% for participant groups defined by SBP reductions of ≥20, 10–19, 0–9 and <0 mm Hg, respectively (p=0.0006 for trend). Conclusions The present analysis provided no evidence of an increase in recurrent stroke associated with larger reductions in SBP produced by treatment among patients with cerebrovascular disease.
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pmid24828894
doi10.1136/jnnp-2014-307856