title: Effects of blood pressure lowering on major vascular events among patients with isolated diastolic hypertension: the perindopril protection against recurrent stroke study (PROGRESS) trial.
abstract: OBJECTIVE
  Despite clear evidence that blood pressure (BP) lowering is effective for prevention of cardiovascular events among patients with isolated systolic hypertension and systolic-diastolic hypertension, there is ongoing uncertainty about its effects in those with isolated diastolic hypertension. The objective of the present analysis is to determine whether BP lowering provides benefits to patients with isolated diastolic hypertension.
  
  
  METHODS
  Patients with cerebrovascular disease and hypertension at baseline (n=4283) were randomly assigned to either active treatment (perindopril in all participants plus indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). The primary outcome was total major vascular events.
  
  
  RESULTS
  There were 1923 patients with isolated systolic hypertension (systolic BP ≥ 140 mm Hg and diastolic BP < 90 mm Hg), 315 with isolated diastolic hypertension (systolic BP <140 mm Hg and diastolic BP ≥ 90 mm Hg), and 2045 with systolic-diastolic hypertension (systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg) at baseline. Active treatment reduced the relative risk of major vascular events by 27% (95% CI, 10% to 41%) among patients with isolated systolic hypertension, by 28% (-29% to 60%) among those with isolated diastolic hypertension, and by 32% (17% to 45%) among those with systolic-diastolic hypertension. There was no evidence of differences in the magnitude of the effects of treatment among different types of hypertension (P homogeneity=0.89).
  
  
  CONCLUSIONS
  BP lowering is likely to provide a similar level of protection against major vascular events for patients with isolated diastolic hypertension as for those with isolated systolic hypertension and systolic-diastolic hypertension. Clinical Trial Registration Information- This trial was not registered because patients were enrolled before July 1, 2005.
authors.affiliation: The George Institute for Global Health, University of Sydney and the Royal Prince Alfred Hospital, Australia.
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
authors.forename: Teruo
authors.initials: T
authors.lastname: Omae
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.forename: Jun
authors.initials: J
authors.lastname: Hata
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Stephen
authors.initials: S
authors.lastname: Macmahon
authors.forename: Bruce
authors.initials: B
authors.lastname: Neal
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007190:Indapamide / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000494:pharmacology / Q000627:therapeutic use*; D055502:Secondary Prevention; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D007190:Indapamide; D020913:Perindopril