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Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial

Hisatomi Arima1, John Chalmers, Mark Woodward

  • 1The George Institute for International Health, University of Sydney, Sydney, NSW, Australia.

Journal of Hypertension
|May 11, 2006
PubMed

Insights

Lowering blood pressure (BP) in patients with cerebrovascular disease is beneficial. Intensive BP reduction appears to further decrease stroke recurrence risk without increasing serious complications.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Clinical Trials

Background:

  • Patients with a history of cerebrovascular disease are at high risk for recurrent events.
  • Blood pressure management is a cornerstone of secondary prevention in these patients.
  • The optimal blood pressure target for minimizing recurrent stroke risk remains an area of investigation.

Purpose of the Study:

  • To determine the optimal blood pressure (BP) level for patients with a history of cerebrovascular disease.
  • To investigate the relationship between baseline and achieved BP levels and the risk of recurrent stroke.

Main Methods:

  • Post hoc analyses of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a randomized, placebo-controlled trial involving 6105 patients.
  • Investigated the effects of randomized treatment on recurrent stroke based on baseline BP levels.
  • Conducted an observational analysis of achieved follow-up BP levels and recurrent stroke risk.

Main Results:

  • BP lowering with combination therapy showed similar risk reductions across baseline BP categories.
  • Achieved follow-up BP levels demonstrated that the lowest stroke recurrence risk was associated with the lowest BP levels (median 112/72 mmHg).
  • Minor side-effects increased with lower BP, but serious complications did not increase.

Conclusions:

  • No evidence of a J-curve relationship between BP level and stroke risk in patients with cerebrovascular disease.
  • Intensive BP lowering is expected to yield greater risk reductions in this patient population.
  • Further research may refine BP targets for optimal stroke prevention.
Abstract

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