Division of Hypertension, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Xicheng District, Beijing, China.
Hypertens Res. 2009 Nov;32(11):1032-40. doi: 10.1038/hr.2009.139. Epub 2009 Oct 2.
We assessed, in a double-blind, placebo-controlled trial, whether lowering blood pressure (BP) prevents the recurrence of stroke in Chinese patients with cerebrovascular disease. Patients were randomized into two groups: 2825 patients received a placebo and 2840 patients received 2.5 mg of indapamide daily. The primary and secondary outcomes were the recurrence of fatal or nonfatal stroke and major fatal and nonfatal cardiovascular events, respectively. The average systolic/diastolic BP at randomization was 153.8/92.8 mm Hg. At median follow-up (2 years), BP was, on an average, 6.8/3.3 mm Hg lower in patients on active treatment. In total, 143 patients on indapamide and 219 patients on placebo had recurrent strokes (hazard ratio for indapamide, 0.69; 95% confidence interval (CI): 0.54-0.89; P<0.001). In addition, 199 patients on indapamide and 258 patients on placebo had a cardiovascular event (hazard ratio, 0.75; 95% CI: 0.89-0.62; P=0.002). We performed a systematic review of literature that included our new results. Across 10 trials, the odds ratio for the prevention of stroke recurrence by BP lowering was 0.78 (95% CI: 0.68-0.90; P=0.0007). The pooled odds ratio was 0.63 (95% CI: 0.54-0.73; P<0.0001) for trials involving diuretics as a component of therapy and 0.93 (95% CI: 0.87-1.01; P=0.086) for trials in which treatment included renin system inhibitors (P<0.0001 for heterogeneity). The weighted correlation between the odds for stroke recurrence and the reduction in systolic BP was -0.57 (P=0.067). In conclusion, BP lowering by indapamide treatment reduced the recurrence of stroke and the incidence of cardiovascular events in Chinese patients with cerebrovascular disease. Whether prevention of stroke recurrence depends on drug class, degree of BP lowering or both requires further investigation.
我们在一项双盲、安慰剂对照试验中评估了降低血压（BP）是否可预防中国脑血管病患者的中风复发。患者被随机分为两组：2825 名患者接受安慰剂治疗，2840 名患者每天接受 2.5 毫克吲达帕胺治疗。主要和次要结局分别为致命或非致命性中风复发和主要致命和非致命性心血管事件。随机分组时的平均收缩压/舒张压为 153.8/92.8mmHg。在中位随访（2 年）期间，接受活性治疗的患者的血压平均降低了 6.8/3.3mmHg。共有 143 名吲达帕胺组患者和 219 名安慰剂组患者出现中风复发（吲达帕胺组的风险比为 0.69；95%置信区间[CI]：0.54-0.89；P<0.001）。此外，199 名吲达帕胺组患者和 258 名安慰剂组患者发生心血管事件（风险比为 0.75；95%CI：0.89-0.62；P=0.002）。我们对包括我们新结果在内的文献进行了系统评价。在 10 项试验中，通过降低血压预防中风复发的比值比为 0.78（95%CI：0.68-0.90；P=0.0007）。纳入治疗中包含利尿剂的试验的合并比值比为 0.63（95%CI：0.54-0.73；P<0.0001），纳入包含肾素系统抑制剂的治疗的试验的合并比值比为 0.93（95%CI：0.87-1.01；P=0.086）（P<0.0001 用于异质性检验）。中风复发的几率与收缩压降低之间的加权相关性为-0.57（P=0.067）。总之，吲达帕胺治疗降低血压可降低中国脑血管病患者的中风复发和心血管事件发生率。中风复发的预防是否取决于药物类别、降压程度或两者都需要进一步研究。
