Perindopril-based blood pressure lowering in individuals with cerebrovascular disease: consistency of benefits by age, sex and region.
OBJECTIVE
To assess the consistency of the benefits of blood pressure lowering on secondary stroke risk by age, sex and geographic region of recruitment.


METHODS
Randomized, placebo-controlled trial. Participants were randomized to the angiotensin-converting enzyme (ACE) inhibitor perindopril (plus the diuretic indapamide if not indicated or contraindicated) or to placebo(s) over a mean follow-up of 3.9 years. Main analyses used Cox proportional hazards models on an intention-to-treat basis. Subgroup results were standardized for the proportion (42%) taking single-drug therapy.


METHODS
A total of 172 centres in Asia, Australia, New Zealand and Europe.


METHODS
Patients (n = 6105) with a history of stroke or transient ischaemic attack, of whom 50% were aged over 65 years at baseline, 30% were women and 39% were from Asia.


METHODS
Stroke, coronary heart disease and major vascular events.


RESULTS
Overall, treatment reduced stroke by 28% [95% confidence interval (CI) 17-38%] and major vascular events by 26% (16-44%), with separately significant reductions across subgroups defined by age (< or > or = 65 years), sex and region (Asia or not). Treatment was safe and well tolerated, and the absolute benefits were large; 5 years' treatment would be expected to avert at least one major vascular event among every 20 patients in all age, sex and region subgroups. There was some evidence of particularly large benefits among younger participants and those from Asia.


CONCLUSIONS
Blood pressure lowering reduces secondary stroke risk, with large absolute benefits across groups defined by age, sex and geographic region.
Rodgers
Anthony
A
Clinical Trials Research Unit, University of Auckland, New Zealand.
Chapman
Neil
N
Woodward
Mark
M
Liu
Li-Sheng
LS
Colman
Sam
S
Lee
Arier
A
Chalmers
John
J
MacMahon
Stephen
S
D017677:Age Distribution; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D001794:Blood Pressure / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*
D000806:Angiotensin-Converting Enzyme Inhibitors; D020913:Perindopril