Arima Hisatomi, Tzourio Christophe, Butcher Ken, Anderson Craig, Bousser Marie-Germaine, Lees Kennedy R, Reid John L, Omae Teruo, Woodward Mark, MacMahon Stephen, Chalmers John
The George Institute for International Health, University of Sydney, Australia.
Stroke. 2006 Jun;37(6):1497-502. doi: 10.1161/01.STR.0000221212.36860.c9. Epub 2006 Apr 20.
The relationship between baseline and recurrent vascular events may be important in the targeting of secondary prevention strategies. We examined the relationship between initial event and various types of further vascular outcomes and associated effects of blood pressure (BP)-lowering.
Subsidiary analyses of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial, a randomized, placebo-controlled trial that established the benefits of BP-lowering in 6105 patients (mean age 64 years, 30% female) with cerebrovascular disease, randomly assigned to either active treatment (perindopril for all, plus indapamide in those with neither an indication for, nor a contraindication to, a diuretic) or placebo(s).
Stroke subtypes and coronary events were associated with 1.5- to 6.6-fold greater risk of recurrence of the same event (hazard ratios, 1.51 to 6.64; P=0.1 for large artery infarction, P<0.0001 for other events). However, 46% to 92% of further vascular outcomes were not of the same type. Active treatment produced comparable reductions in the risk of vascular outcomes among patients with a broad range of vascular events at entry (relative risk reduction, 25%; P<0.0001 for ischemic stroke; 42%, P=0.0006 for hemorrhagic stroke; 17%, P=0.3 for coronary events; P homogeneity=0.4).
Patients with previous vascular events are at high risk of recurrences of the same event. However, because they are also at risk of other vascular outcomes, a broad range of secondary prevention strategies is necessary for their treatment. BP-lowering is likely to be one of the most effective and generalizable strategies across a variety of major vascular events including stroke and myocardial infarction.
在二级预防策略的目标设定中，基线血管事件与复发性血管事件之间的关系可能具有重要意义。我们研究了初始事件与各类进一步血管结局之间的关系以及降压治疗的相关影响。
培哚普利预防复发性卒中研究（PROGRESS）试验的子分析，这是一项随机、安慰剂对照试验，在6105例（平均年龄64岁，30%为女性）脑血管疾病患者中证实了降压治疗的益处，这些患者被随机分配接受活性治疗（所有人均服用培哚普利，对于无使用利尿剂指征且无禁忌证的患者加用吲达帕胺）或安慰剂。
卒中亚型和冠状动脉事件与同一事件复发风险高1.5至6.6倍相关（风险比，1.51至6.64；大动脉梗死P = 0.1，其他事件P<0.0001）。然而，46%至92%的进一步血管结局并非同一类型。活性治疗在入组时具有广泛血管事件的患者中，使血管结局风险得到了类似程度的降低（相对风险降低，25%；缺血性卒中P<0.0001；出血性卒中42%，P = 0.0006；冠状动脉事件17%，P = 0.3；P同质性 = 0.4）。
既往有血管事件的患者发生同一事件复发的风险很高。然而，由于他们也有发生其他血管结局的风险，因此需要采用广泛的二级预防策略对其进行治疗。降压治疗可能是包括卒中和心肌梗死在内的各种主要血管事件中最有效且可推广的策略之一。
