Perindopril-based blood pressure lowering reduces major vascular events in Asian and Western participants with cerebrovascular disease: the PROGRESS trial
Perindopril-based blood pressure lowering reduces major vascular events in Asian and Western participants with cerebrovascular disease: the PROGRESS trial
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DOI：
10.1097/hjh.0b013e328333b009
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发表时间：
2010-02-01
影响因子：
4.9
通讯作者：
Chalmers, John
中科院分区：
文献类型：
--
作者：
Arima, Hisatomi;Anderson, Craig;Chalmers, John
目的评估降压对亚洲和西方参与者血管事件的益处，特别强调卒中亚型和心脏结局。方法这是培哚普利预防复发性卒中研究的辅助分析（PROGRESS），一项随机、安慰剂对照试验，在6105例脑血管疾病患者中确定了降压的益处，随机分配至活性药物治疗组（所有患者均接受培哚普利治疗，无利尿剂适应症或禁忌症的患者接受吲达帕胺治疗）或安慰剂组。结果是总的和特定原因的血管outcome.Results总的主要血管事件的年发生率为4.2%，在亚洲和西方参与者的5.2%。亚洲受试者的总体卒中发生率高于西方受试者，亚洲受试者的腔隙性梗死和出血性卒中比例更高，西方受试者的心源性栓塞性梗死和大动脉梗死比例更高。积极治疗使亚洲受试者的血压降低了10.3/4.6 mmHg，西方受试者降低了8.1/3.6 mmHg。在亚洲受试者中，主要血管事件减少了38% [95%置信区间（CI）23-49%]，而西方受试者减少了20%（95% CI 7-31%）（P同质性=0.06）。同样，亚洲受试者中所有其他结局的相对风险降低更高，但仅心力衰竭和血管性死亡达到统计学显著性（各P=0.02）。5年内主要血管事件需要治疗的人数在亚洲为15人（95%CI 10-26），而在西方参与者中为28人（95%CI 17-94）（P同质性=0.09）。J Hypertens 28：395-400（C）2010 Wolters Kluwer Health竖条Lippincott威廉姆斯& Wilkins.
Objective To assess the benefits of blood pressure (BP) lowering on vascular events separately for Asian and for Western participants with particular emphasis on stroke subtypes and cardiac outcomes.Methods This is a subsidiary analysis of Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a randomized, placebo-controlled trial that established the benefits of BP lowering in 6105 patients with cerebrovascular disease, randomly assigned to either active treatment (perindopril for all, and indapamide for those with neither an indication for, nor a contraindication to, a diuretic) or placebo(s). Outcomes are total and cause-specific vascular outcomes.Results The annual rates for total major vascular events were 4.2% in Asian and 5.2% in Western participants. Overall stroke rates were greater in Asian compared to Western participants with proportionally more lacunar infarctions and haemorrhagic strokes in Asians and more cardioembolic infarctions and large artery infarctions in Western participants. Active treatment reduced BP by 10.3/4.6 mmHg in Asian, and by 8.1/3.6 mmHg in Western participants. Among Asian participants there was a 38% [95% confidence interval (CI) 23-49%] reduction in major vascular events compared to a 20% (95% CI 7-31%) reduction in Western participants (Phomogeneity=0.06). Similarly, there were higher relative risk reductions for all other outcomes among Asian participants, but this only reached statistical significance for heart failure and vascular death (P=0.02 for each). The number needed to treat for major vascular events over 5 years was 15 (95% CI 10-26) in Asian compared to 28 (95% CI 17-94) in Western participants (P homogeneity=0.09).Conclusions BP lowering reduces the risk of major vascular events, with separately significant reductions, in both Asia and the West. J Hypertens 28: 395-400 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.