Lower blood pressure and risk of recurrent stroke in patients with chronic kidney disease: PROGRESS trial
Lower blood pressure and risk of recurrent stroke in patients with chronic kidney disease: PROGRESS trial
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DOI：
10.1038/ki.2008.5
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发表时间：
2008-04-01
影响因子：
19.6
通讯作者：
Chalmers, J.
中科院分区：
文献类型：
--
作者：
Ninomiya, T.;Perkovic, V.;Chalmers, J.
最近的流行病学研究表明，慢性肾脏病（CKD）患者的卒中风险与收缩压（SBP）水平之间存在J形相关性。培哚普利预防复发性卒中研究（PROGRESS）是一项随机、安慰剂对照试验，证明基于培哚普利的血压（BP）降低可降低6105例既往患有脑血管疾病的参与者的卒中风险。我们根据基线血压和随访血压与卒中风险之间的关系，评估了治疗对1757例3期或3期以上CKD患者复发卒中风险的影响。在所有基线SBP水平下，活性治疗均可显著降低卒中风险。年龄和性别校正的卒中发生率显著增加，达到的SBP水平和卒中/1000人-年呈对数线性关系。在调整潜在混杂因素后，这种相关性仍然存在。我们发现，基于培哚普利的降血压有效地预防了CKD患者的复发性卒中，在广泛的BP水平范围内，没有证据表明低BP水平人群的卒中风险增加。
Recent epidemiological studies have shown a J-shaped association between the risk of stroke and systolic blood pressure (SBP) levels in people with chronic kidney disease (CKD). The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, placebo-controlled trial demonstrating that perindopril-based blood pressure (BP) lowering reduced the risk of stroke in 6105 participants with prior cerebrovascular disease. We estimated the effects of therapy on the risk of recurrent stroke in 1757 of these participants with stage 3 or greater CKD according to baseline BP and the relationship between achieved follow-up BP and the risk of stroke. Active therapy produced comparable and significant reductions in the risk of stroke across all baseline SBP levels. The age- and gender-adjusted incidence of stroke increased significantly in a log-linear relationship for achieved SBP levels and strokes per 1000 person-years. This association persisted after adjusting for potential confounding factors. We found that perindopril-based BP lowering effectively prevented recurrent stroke in people with CKD, across a wide range of BP levels, without evidence of an increased risk of stroke in people with low BP levels.