Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke : The PROGRESS (Perindopril Protection Against Recurrent Stroke Study) magnetic resonance imaging substudy
Identifieur interne : 00A663 ( Main/Exploration ); précédent : 00A662; suivant : 00A664Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke : The PROGRESS (Perindopril Protection Against Recurrent Stroke Study) magnetic resonance imaging substudy
Auteurs : Carole Dufouil [France] ; John Chalmers [Australie] ; Oguzhan Coskun [France] ; Véronique Besancon [France] ; Marie-Germaine Bousser [France] ; Pierre Guillon [France] ; Stephen Macmahon [Australie] ; Bernard Mazoyer [France] ; Bruce Neal [Australie] ; Mark Woodward [Australie] ; Nathalie Tzourio-Mazoyer [France] ; Christophe Tzourio [France, Australie]Source :
- Circulation : (New York, N.Y.) [ 0009-7322 ] ; 2005.
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Abstract
Background-The prevalence of white matter hyperintensities (WMHs) detected on cerebral MRI is associated with hypertension, but it is not known whether blood pressure lowering can arrest their progression. We report here the results of an MRI substudy of PROGRESS (Perindopril Protection Against Recurrent Stroke Study), a randomized trial of blood pressure lowering in subjects with cerebrovascular disease. Methods and Results-The substudy comprised 192 participants who had a cerebral MRI both at baseline and after a mean follow-up time of 36 months (SD=6.0 months). At the first MRI, WMHs were graded with a visual rating scale from A (no WMH) to D (severe WMH). Participants were assigned to a combination of perindopril plus indapamide (or their placebos; 58%) or to single therapy with perindopril (or placebo). At the time of the second MRI, the blood pressure reduction in the active arm compared with the placebo arm was 11.2 mm Hg for systolic blood pressure and 4.3 mm Hg for diastolic blood pressure. Twenty-four subjects (12.5%) developed new WMHs at follow-up. The risk of new WMH was reduced by 43% (95% CI -7% to 89%) in the active treatment group compared with the placebo group (P=0.17). The mean total volume of new WMHs was significantly reduced in the active treatment group (0.4 mm3 [SE=0.8]) compared with the placebo group (2.0 mm3 [SE=0.7]; P=0.012). This difference was greatest for patients with severe WMH at entry, 0.0 mm3 (SE=0) in the active treatment group versus 7.6 mm3 (SE=1.0) in the placebo group (P<0.0001). Conclusions-These results indicate that an active blood pressure-lowering regimen stopped or delayed the progression of WMHs in patients with cerebrovascular disease.
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type="wicri:Area/Main/Exploration">00A663</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Effects of blood pressure lowering on cerebral white matter hyperintensities in patients with stroke : The PROGRESS (Perindopril Protection Against Recurrent Stroke Study) magnetic resonance imaging substudy</title><author><name sortKey="Dufouil, Carole" sort="Dufouil, Carole" uniqKey="Dufouil C" first="Carole" last="Dufouil">Carole Dufouil</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>INSERM U708</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>12 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="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>George Institute for International Health</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Coskun, Oguzhan" sort="Coskun, Oguzhan" uniqKey="Coskun O" first="Oguzhan" last="Coskun">Oguzhan Coskun</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</s1><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>CHU de Caen</wicri:noRegion><wicri:noRegion>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</wicri:noRegion></affiliation></author><author><name sortKey="Besancon, Veronique" sort="Besancon, Veronique" uniqKey="Besancon V" first="Véronique" last="Besancon">Véronique Besancon</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>INSERM U708</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>12 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="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="04"><s1>Service de Neurologie, Hôpital Lariboisière</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ><sZ>12 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="Guillon, Pierre" sort="Guillon, Pierre" uniqKey="Guillon P" first="Pierre" last="Guillon">Pierre Guillon</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</s1><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>CHU de Caen</wicri:noRegion><wicri:noRegion>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</wicri:noRegion></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>George Institute for International Health</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Mazoyer, Bernard" sort="Mazoyer, Bernard" uniqKey="Mazoyer B" first="Bernard" last="Mazoyer">Bernard Mazoyer</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</s1><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>CHU de Caen</wicri:noRegion><wicri:noRegion>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</wicri:noRegion></affiliation></author><author><name sortKey="Neal, Bruce" sort="Neal, Bruce" uniqKey="Neal B" first="Bruce" last="Neal">Bruce Neal</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>George Institute for International Health</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>George Institute for International Health</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Tzourio Mazoyer, Nathalie" sort="Tzourio Mazoyer, Nathalie" uniqKey="Tzourio Mazoyer N" first="Nathalie" last="Tzourio-Mazoyer">Nathalie Tzourio-Mazoyer</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</s1><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>CHU de Caen</wicri:noRegion><wicri:noRegion>UMR6194 CNRS-CEA, and Unite IRM, CHU de Caen</wicri:noRegion></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="01"><s1>INSERM U708</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>12 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="02"><s1>George Institute for International Health</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Service de Neurologie, Hôpital Lariboisière</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ><sZ>12 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></analytic><series><title level="j" type="main">Circulation : (New York, N.Y.)</title><title level="j" type="abbreviated">Circulation : (N. Y. N.Y.)</title><idno type="ISSN">0009-7322</idno><imprint><date when="2005">2005</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Circulation : (New York, N.Y.)</title><title level="j" type="abbreviated">Circulation : (N. Y. N.Y.)</title><idno type="ISSN">0009-7322</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antihypertensive agent</term><term>Arterial pressure</term><term>Blood pressure</term><term>Cardiovascular disease</term><term>Cerebrovascular disease</term><term>Human</term><term>Hyperintensity</term><term>Hypertension</term><term>Nuclear magnetic resonance imaging</term><term>Perindopril</term><term>Stroke</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Appareil circulatoire pathologie</term><term>Accident cérébrovasculaire</term><term>Cérébrovasculaire pathologie</term><term>Hypertension artérielle</term><term>Pression artérielle</term><term>Pression sanguine</term><term>Hyperintensité</term><term>Homme</term><term>Périndopril</term><term>Imagerie RMN</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-The prevalence of white matter hyperintensities (WMHs) detected on cerebral MRI is associated with hypertension, but it is not known whether blood pressure lowering can arrest their progression. We report here the results of an MRI substudy of PROGRESS (Perindopril Protection Against Recurrent Stroke Study), a randomized trial of blood pressure lowering in subjects with cerebrovascular disease. Methods and Results-The substudy comprised 192 participants who had a cerebral MRI both at baseline and after a mean follow-up time of 36 months (SD=6.0 months). At the first MRI, WMHs were graded with a visual rating scale from A (no WMH) to D (severe WMH). Participants were assigned to a combination of perindopril plus indapamide (or their placebos; 58%) or to single therapy with perindopril (or placebo). At the time of the second MRI, the blood pressure reduction in the active arm compared with the placebo arm was 11.2 mm Hg for systolic blood pressure and 4.3 mm Hg for diastolic blood pressure. Twenty-four subjects (12.5%) developed new WMHs at follow-up. The risk of new WMH was reduced by 43% (95% CI -7% to 89%) in the active treatment group compared with the placebo group (P=0.17). The mean total volume of new WMHs was significantly reduced in the active treatment group (0.4 mm<sup>3</sup> [SE=0.8]) compared with the placebo group (2.0 mm<sup>3</sup> [SE=0.7]; P=0.012). This difference was greatest for patients with severe WMH at entry, 0.0 mm<sup>3</sup> (SE=0) in the active treatment group versus 7.6 mm<sup>3</sup> (SE=1.0) in the placebo group (P<0.0001). Conclusions-These results indicate that an active blood pressure-lowering regimen stopped or delayed the progression of WMHs in patients with cerebrovascular disease.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li></country><region><li>Nouvelle-Galles du Sud</li><li>Île-de-France</li></region><settlement><li>Paris</li><li>Sydney</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Dufouil, Carole" sort="Dufouil, Carole" uniqKey="Dufouil C" first="Carole" last="Dufouil">Carole Dufouil</name></region><name sortKey="Besancon, Veronique" sort="Besancon, Veronique" uniqKey="Besancon V" first="Véronique" last="Besancon">Véronique Besancon</name><name sortKey="Bousser, Marie Germaine" sort="Bousser, Marie Germaine" uniqKey="Bousser M" first="Marie-Germaine" last="Bousser">Marie-Germaine Bousser</name><name sortKey="Coskun, Oguzhan" sort="Coskun, Oguzhan" uniqKey="Coskun O" first="Oguzhan" last="Coskun">Oguzhan Coskun</name><name sortKey="Guillon, Pierre" sort="Guillon, Pierre" uniqKey="Guillon P" first="Pierre" last="Guillon">Pierre Guillon</name><name sortKey="Mazoyer, Bernard" sort="Mazoyer, Bernard" uniqKey="Mazoyer B" first="Bernard" last="Mazoyer">Bernard Mazoyer</name><name sortKey="Tzourio Mazoyer, Nathalie" sort="Tzourio Mazoyer, Nathalie" uniqKey="Tzourio Mazoyer N" first="Nathalie" last="Tzourio-Mazoyer">Nathalie Tzourio-Mazoyer</name><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><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name></region><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="Tzourio, Christophe" sort="Tzourio, Christophe" uniqKey="Tzourio C" first="Christophe" last="Tzourio">Christophe Tzourio</name><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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