TY - JOUR
T1 - Perindopril-based blood pressure-lowering reduces major vascular events in patients with atrial fibrillation and prior stroke or transient ischemic attack
AU - Arima, Hisatomi
AU - Hart, Robert G.
AU - Colman, Sam
AU - Chalmers, John
AU - Anderson, Craig
AU - Rodgers, Anthony
AU - Woodward, Mark
AU - MacMahon, Stephen
AU - Neal, Bruce
PY - 2005/10
Y1 - 2005/10
N2 - Background and Purpose - Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering provides additional protection for this high-risk patient group. Methods - This study was a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)-a randomized, placebo-controlled trial that established the beneficial effects of blood pressure-lowering in a heterogeneous group of patients with cerebrovascular disease. A total of 6105 patients were randomly assigned to either active treatment (2 to 4 mg perindopril for all participants plus 2.0 to 2.5 mg indapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, cause-specific vascular outcomes, and death from any cause. Results - There were 476 patients with atrial fibrillation at baseline, of whom 51% were taking anticoagulants. In these patients, active treatment lowered mean blood pressure by 7.3/3.4 mm Hg and was associated with a 38% (95% confidence interval [CI], 6 to 59) reduction in major vascular events and 34% (95% CI, -13 to 61) reduction in stroke. The benefits of blood pressure-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hypertension (P homogeneity=0.4). Conclusions - For most patients with atrial fibrillation, routine blood pressure-lowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.
AB - Background and Purpose - Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering provides additional protection for this high-risk patient group. Methods - This study was a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)-a randomized, placebo-controlled trial that established the beneficial effects of blood pressure-lowering in a heterogeneous group of patients with cerebrovascular disease. A total of 6105 patients were randomly assigned to either active treatment (2 to 4 mg perindopril for all participants plus 2.0 to 2.5 mg indapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, cause-specific vascular outcomes, and death from any cause. Results - There were 476 patients with atrial fibrillation at baseline, of whom 51% were taking anticoagulants. In these patients, active treatment lowered mean blood pressure by 7.3/3.4 mm Hg and was associated with a 38% (95% confidence interval [CI], 6 to 59) reduction in major vascular events and 34% (95% CI, -13 to 61) reduction in stroke. The benefits of blood pressure-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hypertension (P homogeneity=0.4). Conclusions - For most patients with atrial fibrillation, routine blood pressure-lowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.
KW - Antihypertensive agents
KW - Atrial fibrillation
KW - Randomized, controlled trials
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=26444553309&partnerID=8YFLogxK
U2 - 10.1161/01.STR.0000181115.59173.42
DO - 10.1161/01.STR.0000181115.59173.42
M3 - Article
C2 - 16141420
AN - SCOPUS:26444553309
SN - 0039-2499
VL - 36
SP - 2164
EP - 2169
JO - Stroke
JF - Stroke
IS - 10
ER -