Arima Hisatomi, Chalmers John, Woodward Mark, Anderson Craig, Rodgers Anthony, Davis Stephen, Macmahon Stephen, Neal Bruce
The George Institute for International Health, University of Sydney, Sydney, NSW, Australia.
J Hypertens. 2006 Jun;24(6):1201-8. doi: 10.1097/01.hjh.0000226212.34055.86.
To explore the likely optimum blood pressure (BP) level for patients with a history of cerebrovascular disease.
The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, placebo-controlled trial that established the beneficial effects of BP lowering in 6105 patients with cerebrovascular disease. The present study comprises two series of post hoc analyses. The first was designed to investigate the effects of randomized treatment on recurrent stroke by baseline BP levels, and the second was a corresponding observational analysis investigating the association between achieved follow-up BP levels and recurrent stroke risk.
Analyses of the randomized treatment comparisons showed that BP lowering with combination therapy produced similar risk reductions in each of four subgroups defined by baseline BP of less than 120, 120-139, 140-159, and 160 mmHg or greater (P homogeneity = 0.5). The effects of single-drug therapy were also comparable across these subgroups (P homogeneity = 0.2), but consistently greater benefits were observed with combination compared to single-drug therapy. The analyses of achieved follow-up BP showed that the lowest risk of recurrence was among the one-quarter of participants with the lowest follow-up BP levels (median 112/72 mmHg), and that risks rose progressively with higher follow-up BP levels. Minor side-effects were progressively more common at lower BP levels (P homogeneity = 0.04), but there was no excess of serious complications (all P homogeneity > 0.2).
These analyses provide no evidence of a J-curve relationship between BP level and stroke risk among patients with cerebrovascular disease, and identify no patient group among whom more intensive BP lowering would not be expected to produce greater risk reductions.
探讨有脑血管疾病病史患者可能的最佳血压水平。
培哚普利预防复发性卒中研究（PROGRESS）是一项随机、安慰剂对照试验，证实了6105例脑血管疾病患者降压治疗的有益效果。本研究包括两个系列的事后分析。第一个旨在按基线血压水平研究随机治疗对复发性卒中的影响，第二个是相应的观察性分析，研究随访时达到的血压水平与复发性卒中风险之间的关联。
随机治疗比较分析显示，联合治疗降压在基线血压低于120、120 - 139、140 - 159以及160 mmHg或更高所定义的四个亚组中，降低风险的效果相似（P同质性 = 0.5）。单药治疗在这些亚组中的效果也具有可比性（P同质性 = 0.2），但与单药治疗相比，联合治疗始终显示出更大的益处。对随访时达到的血压进行的分析表明，复发风险最低的是随访血压水平最低的四分之一参与者（中位数112/72 mmHg），且风险随随访血压水平升高而逐渐增加。较低血压水平时轻微副作用逐渐更为常见（P同质性 = 0.04），但严重并发症并无增加（所有P同质性 > 0.2）。
这些分析未提供证据表明脑血管疾病患者的血压水平与卒中风险之间存在J曲线关系，也未发现有哪类患者群体强化降压不会带来更大的风险降低。
