Effects of Blood Pressure Lowering on Major Vascular Events Among Patients With Isolated Diastolic Hypertension The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) Trial
Effects of Blood Pressure Lowering on Major Vascular Events Among Patients With Isolated Diastolic Hypertension The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) Trial
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DOI：
10.1161/strokeaha.110.606764
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发表时间：
2011-08-01
期刊：
影响因子：
8.3
通讯作者：
Chalmers, John
中科院分区：
文献类型：
--
作者：
Arima, Hisatomi;Anderson, Craig;Chalmers, John
背景和目的：尽管有明确的证据表明，降低血压（BP）可有效预防单纯收缩期高血压和收缩-舒张期高血压患者的心血管事件，但其在单纯舒张期高血压患者中的作用仍不确定。本分析的目的是确定血压降低是否为孤立性舒张期高血压患者提供益处。方法脑血管疾病和高血压患者基线（n = 4283）被随机分配到积极治疗（培哚普利在所有参与者加吲达帕胺的那些既没有适应症也没有禁忌症利尿剂）或匹配的安慰剂。主要结果是总的主要血管events.Results-There有1923例患者在基线时患有单纯收缩期高血压（收缩压>= 140 mm Hg，舒张压= 140 mm Hg，舒张压>= 90 mm Hg）。在单纯收缩期高血压患者中，积极治疗使主要血管事件的相对风险降低了27%（95% CI，10%至41%），在单纯舒张期高血压患者中降低了28%（-29%至60%），在收缩-舒张期高血压患者中降低了32%（17%至45%）。没有证据表明不同类型的高血压（P同质性=0.89）之间的治疗效果的大小差异。结论-血压降低可能提供一个类似的水平，对主要血管事件的保护与孤立性舒张期高血压患者的孤立性收缩期高血压和收缩-舒张期高血压。
Background and Purpose-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 = 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.