Hisatomi Arima1, Craig Anderson1, Teruo Omae2, Mark Woodward1, Stephen MacMahon3, Giuseppe Mancia4, Marie-Germaine Bousser5, Christophe Tzourio6, Stephen Harrap7, Lisheng Liu8, Bruce Neal1, John Chalmers1. 1. The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia. 2. National Cerebral and Cardiovascular Center, Suita, Japan. 3. The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia George Centre of Healthcare Innovation, University of Oxford, Oxford, UK. 4. Università Milano-Bicocca, Ospedale San Gerardo, Milan, Italy. 5. The Department of Neurology, Hôpital Lariboisière, Paris, France. 6. INSERM U897, Bordeaux, France University of Bordeaux, Bordeaux, France. 7. Department of Physiology, University of Melbourne, Melbourne, Australia. 8. National Centre for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
RCT Entities:
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Alessandro Biffi; Christopher D Anderson; Thomas W K Battey; Alison M Ayres; Steven M Greenberg; Anand Viswanathan; Jonathan Rosand Journal: JAMA Date: 2015-09-01 Impact factor: 56.272
Authors: Jie-Hua Su; Ling-Wei Meng; Di Dong; Wen-Yan Zhuo; Jian-Ming Wang; Li-Bin Liu; Yi Qin; Ye Tian; Jie Tian; Zhao-Hui Li Journal: BMC Med Imaging Date: 2020-07-08 Impact factor: 1.930
Authors: Blake F Giarola; James Leyden; Sally Castle; Jim Jannes; Craig Anderson; Jonathan Newbury; Timothy Kleinig Journal: Cerebrovasc Dis Extra Date: 2018-08-23