Degree of blood pressure reduction and recurrent stroke: the PROGRESS trial.
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.


METHODS
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.
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Hisatomi
H
Arima
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Craig
C
Anderson
National Cerebral and Cardiovascular Center, Suita, Japan.
Teruo
T
Omae
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Mark
M
Woodward
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia George Centre of Healthcare Innovation, University of Oxford, Oxford, UK.
Stephen
S
MacMahon
Università Milano-Bicocca, Ospedale San Gerardo, Milan, Italy.
Giuseppe
G
Mancia
The Department of Neurology, Hôpital Lariboisière, Paris, France.
Marie-Germaine
MG
Bousser
INSERM U897, Bordeaux, France University of Bordeaux, Bordeaux, France.
Christophe
C
Tzourio
Department of Physiology, University of Melbourne, Melbourne, Australia.
Stephen
S
Harrap
National Centre for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Lisheng
L
Liu
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
Bruce
B
Neal
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
John
J
Chalmers
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000503:physiopathology
D000959:Antihypertensive Agents; D020913:Perindopril
Epidemiology; Stroke