The George Institute for International Health, University of Sydney and the Royal Prince Alfred Hospital, Sydney, Australia.
Stroke. 2010 Feb;41(2):394-6. doi: 10.1161/STROKEAHA.109.563932. Epub 2009 Dec 31.
Patients with cerebral amyloid angiopathy (CAA) are at high risk for intracerebral hemorrhage (ICH), but no effective prevention strategies have been established. The objective is to determine whether lowering of blood pressure (BP) provides protection for this high-risk patient group.
This study is a subsidiary analysis of the PROGRESS trial-a randomized, placebo-controlled trial that established the beneficial effects of BP lowering in patients with cerebrovascular disease; 6105 patients were randomly assigned to either active treatment (perindopril for all participants plus indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo. Outcomes were probable CAA-related ICH as defined by the Boston criteria, probable hypertension-related ICH, and unclassified ICH.
Over a mean follow-up of 3.9 years, 16 probable CAA-related ICH, 51 probable hypertension-related ICH, and 44 unclassified ICH occurred. Active treatment reduced the risk of CAA-related ICH by 77% (95% CI, 19%-93%), that of hypertension-related ICH by 46% (95% CI, 4%-69%), and that of unclassified ICH by 43% (95% CI, -5%-69%). There was no evidence of differences in the magnitude of the effects of treatment among different types of ICH (P homogeneity=0.4).
BP-lowering treatment is likely to provide protection against all types of ICH.
脑淀粉样血管病（CAA）患者发生脑出血（ICH）的风险较高，但尚未建立有效的预防策略。本研究旨在确定降压治疗是否可为这一高危患者群体提供保护。
本研究是 PROGRESS 试验的一项亚组分析，该试验是一项随机、安慰剂对照试验，证明了降压治疗对脑血管病患者有益。6105 例患者被随机分为积极治疗组（所有患者接受培哚普利治疗，无利尿剂适应证或禁忌证者加用吲达帕胺）或匹配安慰剂组。主要转归为波士顿标准定义的可能与 CAA 相关的 ICH、可能与高血压相关的 ICH 和未分类 ICH。
平均随访 3.9 年期间，发生了 16 例可能与 CAA 相关的 ICH、51 例可能与高血压相关的 ICH 和 44 例未分类 ICH。积极治疗使 CAA 相关 ICH 的风险降低了 77%（95%CI，19%-93%），高血压相关 ICH 的风险降低了 46%（95%CI，4%-69%），未分类 ICH 的风险降低了 43%（95%CI，-5%-69%）。不同类型 ICH 之间治疗效果的差异无统计学意义（P 同质性=0.4）。
降压治疗可能为所有类型的 ICH 提供保护。
