Effects of Blood Pressure Lowering on Intracranial and Extracranial Bleeding in Patients on Antithrombotic Therapy: The PROGRESS Trial
Identifieur interne : 005D02 ( Main/Exploration ); précédent : 005D01; suivant : 005D03Effects of Blood Pressure Lowering on Intracranial and Extracranial Bleeding in Patients on Antithrombotic Therapy: The PROGRESS Trial
Auteurs : Hisatomi Arima [Australie] ; Craig Anderson [Australie] ; Teruo Omae [Japon] ; Mark Woodward [Australie] ; Stephen Macmahon [Australie, Royaume-Uni] ; Giuseppe Mancia [Italie] ; Marie-Germaine Bousser [France] ; Christophe Tzourio [France] ; Anthony Rodgers [Australie] ; Bruce Neal [Australie] ; John Chalmers [Australie]Source :
- Stroke : (1970) [ 0039-2499 ] ; 2012.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
Abstract
Background and Purpose-Observational studies demonstrate strong associations between blood pressure and bleeding complications of antithrombotic therapy. The objective was to determine whether blood pressure lowering reduces risks of bleeding in patients on antithrombotic therapy. Methods-This is a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial, a randomized, placebo-controlled trial. A total of 6105 patients with cerebrovascular disease were randomly assigned to either active treatment (perindopril±indapamide) or placebo(s). The outcomes were intracranial and extracranial bleeding. Results-There were 4876 (80%) patients on antithrombotic therapy at baseline. Over a mean follow-up of 3.9 years, 119 intracranial and 123 extracranial bleeding events were observed. Among patients with and without antithrombotic therapy, active treatment lowered blood pressure by 8.9/4.0 and 9.3/3.8 mm Hg and reduced the risks of intracranial bleeding by 46% (95% CI, 7%-69%) and 70% (39%-85%), respectively. However, active treatment did not reduce the risks of extracranial bleeding significantly in either group. Among patients on antithrombotic therapy, the lowest risk of intracranial bleeding was observed in participants with the lowest follow-up systolic blood pressure levels (median, 113 mm Hg). Conclusions-Blood pressure lowering provides protection against intracranial bleeding among patients with cerebrovascular disease including those receiving antithrombotic therapy.
Affiliations:
- Australie, France, Italie, Japon, Royaume-Uni
- Angleterre, Aquitaine, Nouvelle-Aquitaine, Nouvelle-Galles du Sud, Oxfordshire, Île-de-France
- Bordeaux, Oxford, Paris, Sydney
- Université d'Oxford, Université de Sydney
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type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Anderson, Craig" sort="Anderson, Craig" uniqKey="Anderson C" first="Craig" last="Anderson">Craig Anderson</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for Global Health , University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Omae, Teruo" sort="Omae, Teruo" uniqKey="Omae T" first="Teruo" last="Omae">Teruo Omae</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>National Cerebral and Cardiovascular Center</s1><s2>Suita</s2><s3>JPN</s3><sZ>3 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>National Cerebral and Cardiovascular Center</wicri:noRegion></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for Global Health , University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for Global Health , University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>George Centre of Healthcare Innovation, University of Oxford</s1><s2>Oxford</s2><s3>GBR</s3><sZ>5 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation></author><author><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Università Milano-Bicocca , Ospedale San Gerardo</s1><s2>Milano</s2><s3>ITA</s3><sZ>6 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Milano</wicri:noRegion></affiliation></author><author><name sortKey="Bousser, Marie Germaine" sort="Bousser, Marie Germaine" uniqKey="Bousser M" first="Marie-Germaine" last="Bousser">Marie-Germaine Bousser</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Department of Neurology, Hôpital Lariboisière</s1><s2>Paris</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Tzourio, Christophe" sort="Tzourio, Christophe" uniqKey="Tzourio C" first="Christophe" last="Tzourio">Christophe Tzourio</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>NSERM U708</s1><s2>Paris</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>University of Bordeaux</s1><s2>Bordeaux</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Bordeaux</settlement></placeName></affiliation></author><author><name sortKey="Rodgers, Anthony" sort="Rodgers, Anthony" uniqKey="Rodgers A" first="Anthony" last="Rodgers">Anthony Rodgers</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for Global Health , University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for Global Health , University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>George Institute for Global Health , University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author></analytic><series><title level="j" type="main">Stroke : (1970)</title><title level="j" type="abbreviated">Stroke : (1970)</title><idno type="ISSN">0039-2499</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Stroke : (1970)</title><title level="j" type="abbreviated">Stroke : (1970)</title><idno type="ISSN">0039-2499</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antihypertensive agent</term><term>Arterial pressure</term><term>Blood pressure</term><term>Cerebrovascular disease</term><term>Extracranial</term><term>Hemorrhage</term><term>Human</term><term>Hypertension</term><term>Intracranial pressure</term><term>Nervous system diseases</term><term>Pressure effect</term><term>Stroke</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Hémorragie</term><term>Hypertension artérielle</term><term>Pathologie du système nerveux</term><term>Pathologie cérébrovasculaire</term><term>Accident cérébrovasculaire</term><term>Effet pression</term><term>Pression artérielle</term><term>Pression sanguine</term><term>Pression intracrânienne</term><term>Extracrânien</term><term>Homme</term><term>Traitement</term><term>Antihypertenseur</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background and Purpose-Observational studies demonstrate strong associations between blood pressure and bleeding complications of antithrombotic therapy. The objective was to determine whether blood pressure lowering reduces risks of bleeding in patients on antithrombotic therapy. Methods-This is a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial, a randomized, placebo-controlled trial. A total of 6105 patients with cerebrovascular disease were randomly assigned to either active treatment (perindopril±indapamide) or placebo(s). The outcomes were intracranial and extracranial bleeding. Results-There were 4876 (80%) patients on antithrombotic therapy at baseline. Over a mean follow-up of 3.9 years, 119 intracranial and 123 extracranial bleeding events were observed. Among patients with and without antithrombotic therapy, active treatment lowered blood pressure by 8.9/4.0 and 9.3/3.8 mm Hg and reduced the risks of intracranial bleeding by 46% (95% CI, 7%-69%) and 70% (39%-85%), respectively. However, active treatment did not reduce the risks of extracranial bleeding significantly in either group. Among patients on antithrombotic therapy, the lowest risk of intracranial bleeding was observed in participants with the lowest follow-up systolic blood pressure levels (median, 113 mm Hg). Conclusions-Blood pressure lowering provides protection against intracranial bleeding among patients with cerebrovascular disease including those receiving antithrombotic therapy.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Italie</li><li>Japon</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Aquitaine</li><li>Nouvelle-Aquitaine</li><li>Nouvelle-Galles du Sud</li><li>Oxfordshire</li><li>Île-de-France</li></region><settlement><li>Bordeaux</li><li>Oxford</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université d'Oxford</li><li>Université de Sydney</li></orgName></list><tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Arima, Hisatomi" sort="Arima, Hisatomi" uniqKey="Arima H" first="Hisatomi" last="Arima">Hisatomi Arima</name></region><name sortKey="Anderson, Craig" sort="Anderson, Craig" uniqKey="Anderson C" first="Craig" last="Anderson">Craig Anderson</name><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><name sortKey="Rodgers, Anthony" sort="Rodgers, Anthony" uniqKey="Rodgers A" first="Anthony" last="Rodgers">Anthony Rodgers</name><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></country><country name="Japon"><noRegion><name sortKey="Omae, Teruo" sort="Omae, Teruo" uniqKey="Omae T" first="Teruo" last="Omae">Teruo Omae</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name></region></country><country name="Italie"><noRegion><name sortKey="Mancia, Giuseppe" sort="Mancia, Giuseppe" uniqKey="Mancia G" first="Giuseppe" last="Mancia">Giuseppe Mancia</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Bousser, Marie Germaine" sort="Bousser, Marie Germaine" uniqKey="Bousser M" first="Marie-Germaine" last="Bousser">Marie-Germaine Bousser</name></region><name sortKey="Tzourio, Christophe" sort="Tzourio, Christophe" uniqKey="Tzourio C" first="Christophe" last="Tzourio">Christophe Tzourio</name><name sortKey="Tzourio, Christophe" sort="Tzourio, Christophe" uniqKey="Tzourio C" first="Christophe" last="Tzourio">Christophe Tzourio</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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