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Degree of blood pressure reduction and recurrent stroke: the PROGRESS trial
Hisatomi Arima1, Craig Anderson1, Teruo Omae2
1The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Insights
This study found no increased risk of recurrent stroke with larger blood pressure (BP) reductions in patients with cerebrovascular disease. Aggressive BP lowering did not elevate stroke recurrence rates.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Controversy exists regarding the 'J-curve' phenomenon, where both low and high blood pressure (BP) are linked to recurrent stroke risk.
- Understanding the safety of significant BP reduction is crucial for managing patients with cerebrovascular disease.
Purpose of the Study:
- To investigate if substantial treatment-induced reductions in blood pressure (BP) increase the risk of recurrent stroke.
- To clarify the relationship between the magnitude of systolic blood pressure (SBP) reduction and recurrent stroke incidence.
Main Methods:
- Analysis of data from the PROGRESS trial involving 6105 patients with cerebrovascular disease.
- Random assignment to active treatment (perindopril ± indapamide) or placebo.
- Categorization of participants based on systolic blood pressure (SBP) reduction from baseline to assess outcome.
Main Results:
- A total of 727 recurrent strokes were recorded over a mean follow-up of 3.9 years.
- A significant trend (p=0.0006) was observed between SBP reduction magnitude and recurrent stroke risk.
- Annual stroke incidence rates were 2.08%, 2.10%, 2.31%, and 2.96% for SBP reductions of ≥ 20, 10-19, 0-9, and <0 mm Hg, respectively.
Conclusions:
- The study found no evidence supporting an increased risk of recurrent stroke with greater SBP reductions achieved through treatment.
- These findings suggest that intensive BP lowering is safe regarding recurrent stroke in this patient population.
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 <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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