Online citations, reference lists, and bibliographies.

Lower Target Blood Pressures Are Safe And Effective For The Prevention Of Recurrent Stroke: The PROGRESS Trial

Hisatomi Arima, John W. Chalmers, Mark Woodward, Craig Evan Anderson, Anthony Rodgers, Stephen C. Davis, Stephen MacMahon, Bruce Neal
Published 2006 · Medicine
Cite This
Download PDF
Analyze on Scholarcy
Share
Objective To explore the likely optimum blood pressure (BP) level for patients with a history of cerebrovascular disease. Methods The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, placebo-controlled trial that established the beneficial effects of BP lowering in 6105 patients with cerebrovascular disease. The present study comprises two series of post hoc analyses. The first was designed to investigate the effects of randomized treatment on recurrent stroke by baseline BP levels, and the second was a corresponding observational analysis investigating the association between achieved follow-up BP levels and recurrent stroke risk. Results Analyses of the randomized treatment comparisons showed that BP lowering with combination therapy produced similar risk reductions in each of four subgroups defined by baseline BP of less than 120, 120–139, 140–159, and 160 mmHg or greater (P homogeneity = 0.5). The effects of single-drug therapy were also comparable across these subgroups (P homogeneity = 0.2), but consistently greater benefits were observed with combination compared to single-drug therapy. The analyses of achieved follow-up BP showed that the lowest risk of recurrence was among the one-quarter of participants with the lowest follow-up BP levels (median 112/72 mmHg), and that risks rose progressively with higher follow-up BP levels. Minor side-effects were progressively more common at lower BP levels (P homogeneity = 0.04), but there was no excess of serious complications (all P homogeneity > 0.2). Conclusion These analyses provide no evidence of a J-curve relationship between BP level and stroke risk among patients with cerebrovascular disease, and identify no patient group among whom more intensive BP lowering would not be expected to produce greater risk reductions.
This paper references
New joint European Society of Hypertension/European Society of Cardiology guidelines for the management of arterial hypertension.
Xavier Rabasseda (2007)
10.1002/sim.4780070122
Comparison of baseline and repeated measure covariate techniques in the Framingham Heart Study.
L. Adrienne Cupples (1988)
10.1136/bmj.329.7472.970
The PROGRESS trial three years later: time for more action, less distraction
Stephen MacMahon (2004)
Warlow C, for the United Kingdom Transient Ischaemic Attack Collaborative Group. Blood pressure and risk of stroke in patients with cerebrovascular disease
A Rodgers (1996)
and the National High Blood Pressure Education Program Coordinating Committee
A V Chobanian (2003)
10.1097/00004872-200403000-00030
Perindopril-based blood pressure lowering in individuals with cerebrovascular disease: consistency of benefits by age, sex and region
Anthony Rodgers (2004)
10.1161/01.STR.0000062888.90293.AA
Secondary Prevention of Stroke in Italy: A Cross-Sectional Survey in Family Practice
Alessandro Filippi (2003)
10.1001/archinte.163.3.361
Validity of the JNC VI recommendations for the management of hypertension in a general population of Japanese elderly: the Hisayama study.
Hisatomi Arima (2003)
10.1161/01.STR.0000033929.62136.6F
Control of Hypertension and Risk of Stroke Recurrence
Gary Friday (2002)
PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood pressure lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack
P Rashid (2001)
10.1161/01.HYP.29.2.537
Blood pressure lowering for the secondary prevention of myocardial infarction and stroke.
Stephen Macmahon (1997)
10.1016/S0140-6736(01)06984-7
The lowering of blood pressure after stroke
Jan A Staessen (2001)
10.1161/01.STR.0000092488.40085.15
Blood Pressure Reduction and Secondary Prevention of Stroke and Other Vascular Events: A Systematic Review
Parveen A Rashid (2003)
10.1016/s0140-6736(03)14739-3
Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials.
Fiona M Turnbull (2003)
10.1056/NEJMoa021716
A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly.
Lindon M.H. Wing (2003)
Blood pressure and cardiovascular diseases in the Asia-Pacific region
(2003)
10.1161/01.STR.30.9.1991
Preventing ischemic stroke in patients with prior stroke and transient ischemic attack : a statement for healthcare professionals from the Stroke Council of the American Heart Association.
Philip A. Wolf (1999)
Randomised trial of a perindopril-based blood pressure lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack
Stephen MacMahon (2001)
10.1161/01.STR.20.10.1407
Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders.
Lippincott Williams Wilkins (1989)
10.2307/1271123
Epidemiology: Study Design and Data Analysis
Matthew Woodward (1999)
10.1136/bmj.328.7440.634
British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary
Bryan P. Williams (2004)
The Heart Outcomes Prevention Evaluation Study.
Kukin Ml (2001)
10.1161/01.STR.29.9.1806
Blood pressure control and recurrence of hypertensive brain hemorrhage.
Soichi Arakawa (1998)
for the United Kingdom Transient Ischaemic Attack Collaborative Group. Blood pressure and risk of stroke in patients with cerebrovascular disease
A Rodgers (1996)
10.1016/S0140-6736(02)11911-8
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
Prospective Studies Collaboration (2002)
10.1161/01.STR.24.12.1844
The J‐Curve Phenomenon in Stroke Recurrence
Katsumi Irie (1993)
10.1097/00004872-200311000-00002
2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension
Judith Ann Whitworth (2003)



This paper is referenced by
10.1016/j.numecd.2014.01.004
The ideal blood pressure target to prevent cardiovascular disease in type 2 diabetes: a neutral viewpoint.
Simona Frontoni (2014)
10.1016/j.jash.2016.06.027
Controversies in hypertension: is lower blood pressure always better?
Sheldon W Tobe (2016)
10.1002/14651858.CD011575.pub2
Blood pressure targets for hypertension in older adults.
Scott Garrison (2017)
10.1097/HJH.0000000000000253
Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence
Alberto Zanchetti (2014)
Guidelines for management of arterial hypertension
Roland E Schmieder (2007)
10.1161/HYPERTENSIONAHA.107.090290
Blood Pressure Control and Improved Cardiovascular Outcomes in the International Verapamil SR-Trandolapril Study
Giuseppe Mancia (2007)
10.5694/MJA16.00526
Guideline for the diagnosis and management of hypertension in adults - 2016.
Genevieve M Gabb (2016)
10.1007/978-1-4471-5547-8_11
Diagnosis and Investigation of the Hypertensive Patient
Marc Jonathan George (2014)
10.1161/CIRCULATIONAHA.111.033704
Blood pressure control in diabetes mellitus: is lower always better, and how low should it go?
P. Deedwania (2011)
10.1016/j.amjopharm.2011.04.002
Secondary prevention of stroke in the elderly: a review of the evidence.
Ahmed Alhusban (2011)
10.2165/00003495-200969060-00001
Pharmacotherapy for the Secondary Prevention of Stroke
Kazunori Toyoda (2012)
Clinical Case of the Month: A 49 Year-Old Man Who Presents with Left Sided Weakness: An Update on Ischemic Stroke.
Najy Masri (2016)
10.1016/J.RECESP.2016.09.004
Guía ESC 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica
Autores (2016)
10.1212/WNL.0000000000000238
Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia
William J Powers (2014)
10.1111/j.1744-9987.2012.01088.x
Japanese Society for Dialysis Therapy guidelines for management of cardiovascular diseases in patients on chronic hemodialysis.
Hideki Hirakata (2012)
10.1161/CIRCULATIONAHA.110.008870
Blood Pressure Targets Recommended by Guidelines and Incidence of Cardiovascular and Renal Events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)
Giuseppe Mancia (2011)
10.1007/s00508-011-0022-z
Blutdruck Zielwerte auf dem Prüfstand
Joerg Slany (2011)
10.1161/STROKEAHA.115.008821
Systolic Blood Pressure and Mortality After Stroke: Too Low, No Go?
Michelle P Lin (2015)
10.1136/bmj.i708
Different systolic blood pressure targets for people with history of stroke or transient ischaemic attack: PAST-BP (Prevention After Stroke—Blood Pressure) randomised controlled trial
Jonathan Mant (2016)
Interventions to lower blood pressure in secondary stroke prevention
Drs Amit Mistri (2006)
Clinical Trials Limitations of Analyses Based on Achieved Blood Pressure Lessons from the African American Study of Kidney Disease and Hypertension Trial Study Concept and Design Were Executed Analysis and Interpretation of the Data Were Executed
Esa M Davis ()
10.20452/PAMW.1081
Benefits of antihypertensive drugs when blood pressure is below 140/90 mmHg.
Joseph L Izzo (2011)
10.1097/HJH.0b013e3281fc975a
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Giuseppe Mancia (2007)
Contemporary Reviews in Cardiovascular Medicine
A Multifunctional Giant (2010)
ACCF/AHA TASK FORCE MEMBERS
David C. Goff (2013)
10.1016/B978-1-4160-6193-9.10046-6
Primary and Secondary Hypertension
Jon D. Blumenfeld (2012)
10.1016/j.jash.2014.05.002
Lowering blood pressure to prevent stroke recurrence: a systematic review of long-term randomized trials.
Carlos A. Feldstein (2014)
10.1136/jnnp-2016-314386
Medical management of intracerebral haemorrhage
Floris H.B.M. Schreuder (2016)
10.1007/s11560-007-0116-9
Leitlinien der antihypertensiven Therapie
Roland E Schmieder (2007)
10.1001/archinte.167.22.2431
Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003-2004.
Nathan D. Wong (2007)
10.1016/J.HIPERT.2018.05.003
Recomendaciones sobre el tratamiento de la hipertensión arterial en la prevención secundaria del ictus isquémico
Cristina Carapeto Sierra (2018)
10.1161/HYPERTENSIONAHA.113.01922
Aggressive Blood Pressure Lowering Is Dangerous: The J-CurveResponse to Aggressive Blood Pressure Reduction Is Dangerous: The J-Curve: Pro Side of the Argument
Guiseppe Mancia (2014)
See more
Semantic Scholar Logo Some data provided by SemanticScholar