Anti-hypertensive treatment and stroke recurrence: impact of PROGRESS
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概要
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There has been a long debate, whether anti-hypertensive treatment is safe and effective for preventing recurrent stroke. Although anti-hypertensive treatment is known to be effective for preventing first-ever stroke, blood pressure lowering treatment is thought to cause recurrent ischemic stroke especially in some chronic stroke patients with severe obstructive lesions, where decreased cerebrovascular reserve capacity and disturved autoregulation were demonstrated. The perindopril protection against recurrent stroke study (PROGRESS) was designed to clarify the concern about the efficacy and safety of blood-pressure-lowering treatments for the chronic stroke patients.<BR>PROGRESS is a randomized, double-blind, placebo-controlled, international, trial of 6, 105 stroke patients, including 815 Japanese stroke patients. Normotensive or hypertensive patients with a history of stroke or tyransient cerebral ischemia within the previous 5 years were enrolled and were randomly assigned to treatment with the ACE inhibitor perindopril 4 mg or placebo, plus the diuretic indapamide (for individuals in whom it was not considered to be definitely indicated or contraindicated) or placebo. Over 4 years of follow up, active treatment reduced blood pressure by 9/4 mm Hg (from 147/86 mm Hg to 138/82 mm Hg). Perindopril group had a 28% relative risk reduction (95% CI 17-38%, p<0001) in primary endpoint (total strokes). Active treatment also reduced the risk of total major vascular events, significantly (26% relative risk reduction). Interestingly, there were similar reductions in the risk of stroke in hypertensive and non-hypertensive subgroups (all p<0.01).<BR>Through PROGRESS trial, Japanese investigators including myself could learn the at-most importance of mega-trial for obtaining a clear-cut evidence on the targeted clinical concern. According to the PROGRESS results, the blood-pressure-lowering treatmemnt with perindopril and indapamide should be quite safe and ef-fective for preventing recurrent stroke, irrespective of their blood pressure. The clinical significance of PRO-GRESS was fully discussed in the symposium.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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