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Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals: The Perindopril Protection Against Recurrent Stroke Study Trial

There is considerable uncertainty regarding the efficacy of blood pressure–lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protect... Full description

Journal Title: Hypertension (Dallas Tex. 1979), 2010-05, Vol.55 (5), p.1193-1198
Main Author: Czernichow, Sébastien
Other Authors: Ninomiya, Toshiharu , Huxley, Rachel , Kengne, André-Pascal , Batty, G David , Grobbee, Diederick E , Woodward, Mark , Neal, Bruce , Chalmers, John
Format: Electronic Article Electronic Article
Language: English
Subjects:
Aged
Antihypertensive Agents - therapeutic use
Arterial hypertension. Arterial hypotension
Biological and medical sciences
Blood and lymphatic vessels
Body Weight
Cardiology. Vascular system
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - prevention & control
Clinical manifestations. Epidemiology. Investigative techniques. Etiology
Female
Humans
Ischemic Attack, Transient - complications
Ischemic Attack, Transient - epidemiology
Male
Medical sciences
Middle Aged
Obesity - complications
Obesity - epidemiology
Obesity - physiopathology
Overweight - complications
Overweight - epidemiology
Overweight - physiopathology
Perindopril - therapeutic use
Placebos
Proportional Hazards Models
Recurrence
Risk Reduction Behavior
Stroke - epidemiology
Stroke - prevention & control
Publisher: Hagerstown, MD: American Heart Association, Inc
ID: ISSN: 0194-911X
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recordid: cdi_proquest_miscellaneous_733105200
title: Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals: The Perindopril Protection Against Recurrent Stroke Study Trial
format: Article
creator:
  • Czernichow, Sébastien
  • Ninomiya, Toshiharu
  • Huxley, Rachel
  • Kengne, André-Pascal
  • Batty, G David
  • Grobbee, Diederick E
  • Woodward, Mark
  • Neal, Bruce
  • Chalmers, John
subjects:
  • Aged
  • Antihypertensive Agents - therapeutic use
  • Arterial hypertension. Arterial hypotension
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Body Weight
  • Cardiology. Vascular system
  • Cardiovascular Diseases - epidemiology
  • Cardiovascular Diseases - prevention & control
  • Clinical manifestations. Epidemiology. Investigative techniques. Etiology
  • Female
  • Humans
  • Ischemic Attack, Transient - complications
  • Ischemic Attack, Transient - epidemiology
  • Male
  • Medical sciences
  • Middle Aged
  • Obesity - complications
  • Obesity - epidemiology
  • Obesity - physiopathology
  • Overweight - complications
  • Overweight - epidemiology
  • Overweight - physiopathology
  • Perindopril - therapeutic use
  • Placebos
  • Proportional Hazards Models
  • Recurrence
  • Risk Reduction Behavior
  • Stroke - epidemiology
  • Stroke - prevention & control
ispartof: Hypertension (Dallas, Tex. 1979), 2010-05, Vol.55 (5), p.1193-1198
description: There is considerable uncertainty regarding the efficacy of blood pressure–lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure–lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE0.5/0.3 mm Hg), with no difference by body mass index quarters (
language: eng
source:
identifier: ISSN: 0194-911X
fulltext: no_fulltext
issn:
  • 0194-911X
  • 1524-4563
url: Link


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titleImpact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals: The Perindopril Protection Against Recurrent Stroke Study Trial
creatorCzernichow, Sébastien ; Ninomiya, Toshiharu ; Huxley, Rachel ; Kengne, André-Pascal ; Batty, G David ; Grobbee, Diederick E ; Woodward, Mark ; Neal, Bruce ; Chalmers, John
creatorcontribCzernichow, Sébastien ; Ninomiya, Toshiharu ; Huxley, Rachel ; Kengne, André-Pascal ; Batty, G David ; Grobbee, Diederick E ; Woodward, Mark ; Neal, Bruce ; Chalmers, John
descriptionThere is considerable uncertainty regarding the efficacy of blood pressure–lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure–lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 27.8, and ≥27.9 kg/m). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs)0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity ≥0.07) or with the standard definitions of overweight and obesity (<25, 25 to 29, and ≥30 kg/m; all P for heterogeneity ≥0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure–lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
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subjectAged ; Antihypertensive Agents - therapeutic use ; Arterial hypertension. Arterial hypotension ; Biological and medical sciences ; Blood and lymphatic vessels ; Body Weight ; Cardiology. Vascular system ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - prevention & control ; Clinical manifestations. Epidemiology. Investigative techniques. Etiology ; Female ; Humans ; Ischemic Attack, Transient - complications ; Ischemic Attack, Transient - epidemiology ; Male ; Medical sciences ; Middle Aged ; Obesity - complications ; Obesity - epidemiology ; Obesity - physiopathology ; Overweight - complications ; Overweight - epidemiology ; Overweight - physiopathology ; Perindopril - therapeutic use ; Placebos ; Proportional Hazards Models ; Recurrence ; Risk Reduction Behavior ; Stroke - epidemiology ; Stroke - prevention & control
ispartofHypertension (Dallas, Tex. 1979), 2010-05, Vol.55 (5), p.1193-1198
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0Czernichow, Sébastien
1Ninomiya, Toshiharu
2Huxley, Rachel
3Kengne, André-Pascal
4Batty, G David
5Grobbee, Diederick E
6Woodward, Mark
7Neal, Bruce
8Chalmers, John
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0Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals: The Perindopril Protection Against Recurrent Stroke Study Trial
1Hypertension (Dallas, Tex. 1979)
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descriptionThere is considerable uncertainty regarding the efficacy of blood pressure–lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure–lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 27.8, and ≥27.9 kg/m). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs)0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity ≥0.07) or with the standard definitions of overweight and obesity (<25, 25 to 29, and ≥30 kg/m; all P for heterogeneity ≥0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure–lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
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1Antihypertensive Agents - therapeutic use
2Arterial hypertension. Arterial hypotension
3Biological and medical sciences
4Blood and lymphatic vessels
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7Cardiovascular Diseases - epidemiology
8Cardiovascular Diseases - prevention & control
9Clinical manifestations. Epidemiology. Investigative techniques. Etiology
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12Ischemic Attack, Transient - complications
13Ischemic Attack, Transient - epidemiology
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16Middle Aged
17Obesity - complications
18Obesity - epidemiology
19Obesity - physiopathology
20Overweight - complications
21Overweight - epidemiology
22Overweight - physiopathology
23Perindopril - therapeutic use
24Placebos
25Proportional Hazards Models
26Recurrence
27Risk Reduction Behavior
28Stroke - epidemiology
29Stroke - prevention & control
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7Neal, Bruce
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titleImpact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals: The Perindopril Protection Against Recurrent Stroke Study Trial
authorCzernichow, Sébastien ; Ninomiya, Toshiharu ; Huxley, Rachel ; Kengne, André-Pascal ; Batty, G David ; Grobbee, Diederick E ; Woodward, Mark ; Neal, Bruce ; Chalmers, John
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1Antihypertensive Agents - therapeutic use
2Arterial hypertension. Arterial hypotension
3Biological and medical sciences
4Blood and lymphatic vessels
5Body Weight
6Cardiology. Vascular system
7Cardiovascular Diseases - epidemiology
8Cardiovascular Diseases - prevention & control
9Clinical manifestations. Epidemiology. Investigative techniques. Etiology
10Female
11Humans
12Ischemic Attack, Transient - complications
13Ischemic Attack, Transient - epidemiology
14Male
15Medical sciences
16Middle Aged
17Obesity - complications
18Obesity - epidemiology
19Obesity - physiopathology
20Overweight - complications
21Overweight - epidemiology
22Overweight - physiopathology
23Perindopril - therapeutic use
24Placebos
25Proportional Hazards Models
26Recurrence
27Risk Reduction Behavior
28Stroke - epidemiology
29Stroke - prevention & control
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7Neal, Bruce
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abstractThere is considerable uncertainty regarding the efficacy of blood pressure–lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure–lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 27.8, and ≥27.9 kg/m). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs)0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity ≥0.07) or with the standard definitions of overweight and obesity (<25, 25 to 29, and ≥30 kg/m; all P for heterogeneity ≥0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure–lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
copHagerstown, MD
pubAmerican Heart Association, Inc
pmid20212271
doi10.1161/HYPERTENSIONAHA.109.140624
oafree_for_read