Effects of a perindopril-based blood pressure-lowering regimen on the risk of Recurrent Stroke according to Stroke subtype and medical history: The PROGRESS trial
Identifieur interne : 00AC93 ( Main/Exploration ); précédent : 00AC92; suivant : 00AC94Effects of a perindopril-based blood pressure-lowering regimen on the risk of Recurrent Stroke according to Stroke subtype and medical history: The PROGRESS trial
Auteurs : N. Chapman [Royaume-Uni] ; R. Huxley [Australie] ; C. Anderson [Nouvelle-Zélande] ; M. G. Bousser [France] ; J. Chalmers [Australie] ; S. Colman [Australie] ; S. Davis [Australie] ; G. Donnan [Australie] ; S. Macmahon [Australie] ; B. Neal [Australie] ; C. Warlow [Royaume-Uni] ; M. Woodward [Australie]Source :
- Stroke : (1970) [ 0039-2499 ] ; 2004.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Background and Purpose-The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) showed that blood pressure lowering reduced stroke risk in patients with a history of cerebrovascular events. Here, we report the consistency of treatment effects across different stroke subtypes and among major clinical subgroups. Methods-PROGRESS was a randomized, double-blind trial among 6105 people with a prior history of cerebrovascular events. Participants were assigned to active treatment (perindopril for all participants and indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). Results-During a mean of 3.9 years of follow-up, active treatment reduced the absolute rates of ischemic stroke from 10% to 8% (relative risk reduction [RRR], 24%; 95% confidence interval [CI], 10 to 35) and the absolute rates of intracerebral hemorrhage from 2% to 1% (RRR, 50%; 95% CI, 26 to 67). The relative risk of any stroke during follow-up was reduced by 26% (95% CI, 12 to 38) among patients whose baseline cerebrovascular event was an ischemic stroke and by 49% (95% CI, 18 to 68) among those whose baseline event was an intracerebral hemorrhage. There was no evidence that treatment effects were modified by other drug therapies (antiplatelet or other antihypertensive agents), residual neurological signs, atrial fibrillation, or the time since the last cerebrovascular event. Conclusions-Beneficial effects of a perindopril-based treatment regimen were observed for all stroke types and all major clinical subgroups studied. These data suggest that effective blood pressure-lowering therapy should be routinely considered for all patients with a history of cerebrovascular events.
Affiliations:
- Australie, France, Nouvelle-Zélande, Royaume-Uni
- Angleterre, Grand Londres, Nouvelle-Galles du Sud, Victoria (État), Île-de-France
- Londres, Melbourne, Paris, Sydney
- Université de Melbourne, Université de Sydney
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Huxley</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Anderson, C" sort="Anderson, C" uniqKey="Anderson C" first="C." last="Anderson">C. Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Clinical Trials Research Unit, University of Auckland</s1><s2>Auckland</s2><s3>NZL</s3><sZ>3 aut.</sZ></inist:fA14><country>Nouvelle-Zélande</country><wicri:noRegion>Auckland</wicri:noRegion></affiliation></author><author><name sortKey="Bousser, M G" sort="Bousser, M G" uniqKey="Bousser M" first="M. G." last="Bousser">M. G. Bousser</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Hopital Lariboisiere</s1><s2>Paris</s2><s3>FRA</s3><sZ>4 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, J" sort="Chalmers, J" uniqKey="Chalmers J" first="J." last="Chalmers">J. Chalmers</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Colman, S" sort="Colman, S" uniqKey="Colman S" first="S." last="Colman">S. Colman</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Davis, S" sort="Davis, S" uniqKey="Davis S" first="S." last="Davis">S. Davis</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Royal Melbourne Hospital, University of Melbourne</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>7 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region><settlement type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation></author><author><name sortKey="Donnan, G" sort="Donnan, G" uniqKey="Donnan G" first="G." last="Donnan">G. Donnan</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>National Stroke Research Institute</s1><s2>Victoria</s2><s3>AUS</s3><sZ>8 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>National Stroke Research Institute</wicri:noRegion></affiliation></author><author><name sortKey="Macmahon, S" sort="Macmahon, S" uniqKey="Macmahon S" first="S." last="Macmahon">S. Macmahon</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Neal, B" sort="Neal, B" uniqKey="Neal B" first="B." last="Neal">B. Neal</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Warlow, C" sort="Warlow, C" uniqKey="Warlow C" first="C." last="Warlow">C. Warlow</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Neurology, Western General Hospital</s1><s2>Scotland</s2><s3>GBR</s3><sZ>11 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">04-0389140</idno><date when="2004">2004</date><idno type="stanalyst">PASCAL 04-0389140 INIST</idno><idno type="RBID">Pascal:04-0389140</idno><idno type="wicri:Area/PascalFrancis/Corpus">004D93</idno><idno type="wicri:Area/PascalFrancis/Curation">001321</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">004B73</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">004B73</idno><idno type="wicri:doubleKey">0039-2499:2004:Chapman N:effects:of:a</idno><idno type="wicri:Area/Main/Merge">00BA00</idno><idno type="wicri:Area/Main/Curation">00AC93</idno><idno type="wicri:Area/Main/Exploration">00AC93</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Effects of a perindopril-based blood pressure-lowering regimen on the risk of Recurrent Stroke according to Stroke subtype and medical history: The PROGRESS trial</title><author><name sortKey="Chapman, N" sort="Chapman, N" uniqKey="Chapman N" first="N." last="Chapman">N. Chapman</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>St Mary's Hospital</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Huxley, R" sort="Huxley, R" uniqKey="Huxley R" first="R." last="Huxley">R. Huxley</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Anderson, C" sort="Anderson, C" uniqKey="Anderson C" first="C." last="Anderson">C. Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Clinical Trials Research Unit, University of Auckland</s1><s2>Auckland</s2><s3>NZL</s3><sZ>3 aut.</sZ></inist:fA14><country>Nouvelle-Zélande</country><wicri:noRegion>Auckland</wicri:noRegion></affiliation></author><author><name sortKey="Bousser, M G" sort="Bousser, M G" uniqKey="Bousser M" first="M. G." last="Bousser">M. G. Bousser</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Hopital Lariboisiere</s1><s2>Paris</s2><s3>FRA</s3><sZ>4 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, J" sort="Chalmers, J" uniqKey="Chalmers J" first="J." last="Chalmers">J. Chalmers</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Colman, S" sort="Colman, S" uniqKey="Colman S" first="S." last="Colman">S. Colman</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Davis, S" sort="Davis, S" uniqKey="Davis S" first="S." last="Davis">S. Davis</name><affiliation wicri:level="4"><inist:fA14 i1="05"><s1>Royal Melbourne Hospital, University of Melbourne</s1><s2>Melbourne</s2><s3>AUS</s3><sZ>7 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region><settlement type="city">Melbourne</settlement></placeName><orgName type="university">Université de Melbourne</orgName></affiliation></author><author><name sortKey="Donnan, G" sort="Donnan, G" uniqKey="Donnan G" first="G." last="Donnan">G. Donnan</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>National Stroke Research Institute</s1><s2>Victoria</s2><s3>AUS</s3><sZ>8 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>National Stroke Research Institute</wicri:noRegion></affiliation></author><author><name sortKey="Macmahon, S" sort="Macmahon, S" uniqKey="Macmahon S" first="S." last="Macmahon">S. Macmahon</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Neal, B" sort="Neal, B" uniqKey="Neal B" first="B." last="Neal">B. Neal</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Warlow, C" sort="Warlow, C" uniqKey="Warlow C" first="C." last="Warlow">C. Warlow</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Neurology, Western General Hospital</s1><s2>Scotland</s2><s3>GBR</s3><sZ>11 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Scotland</wicri:noRegion></affiliation></author><author><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Institute for International Health, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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><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="2004">2004</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>ACE inhibitor</term><term>Antihypertensive agent</term><term>Cerebrovascular disease</term><term>Hemorrhage</term><term>Ischemia</term><term>Nervous system diseases</term><term>Perindopril</term><term>Risk factor</term><term>Stroke</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Accident cérébrovasculaire</term><term>Périndopril</term><term>Facteur risque</term><term>Ischémie</term><term>Inhibiteur angiotensin converting enzyme</term><term>Hémorragie</term><term>Système nerveux pathologie</term><term>Cérébrovasculaire pathologie</term><term>Antihypertenseur</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background and Purpose-The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) showed that blood pressure lowering reduced stroke risk in patients with a history of cerebrovascular events. Here, we report the consistency of treatment effects across different stroke subtypes and among major clinical subgroups. Methods-PROGRESS was a randomized, double-blind trial among 6105 people with a prior history of cerebrovascular events. Participants were assigned to active treatment (perindopril for all participants and indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). Results-During a mean of 3.9 years of follow-up, active treatment reduced the absolute rates of ischemic stroke from 10% to 8% (relative risk reduction [RRR], 24%; 95% confidence interval [CI], 10 to 35) and the absolute rates of intracerebral hemorrhage from 2% to 1% (RRR, 50%; 95% CI, 26 to 67). The relative risk of any stroke during follow-up was reduced by 26% (95% CI, 12 to 38) among patients whose baseline cerebrovascular event was an ischemic stroke and by 49% (95% CI, 18 to 68) among those whose baseline event was an intracerebral hemorrhage. There was no evidence that treatment effects were modified by other drug therapies (antiplatelet or other antihypertensive agents), residual neurological signs, atrial fibrillation, or the time since the last cerebrovascular event. Conclusions-Beneficial effects of a perindopril-based treatment regimen were observed for all stroke types and all major clinical subgroups studied. These data suggest that effective blood pressure-lowering therapy should be routinely considered for all patients with a history of cerebrovascular events.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Nouvelle-Zélande</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Nouvelle-Galles du Sud</li><li>Victoria (État)</li><li>Île-de-France</li></region><settlement><li>Londres</li><li>Melbourne</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université de Melbourne</li><li>Université de Sydney</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Chapman, N" sort="Chapman, N" uniqKey="Chapman N" first="N." last="Chapman">N. Chapman</name></region><name sortKey="Warlow, C" sort="Warlow, C" uniqKey="Warlow C" first="C." last="Warlow">C. Warlow</name></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Huxley, R" sort="Huxley, R" uniqKey="Huxley R" first="R." last="Huxley">R. Huxley</name></region><name sortKey="Chalmers, J" sort="Chalmers, J" uniqKey="Chalmers J" first="J." last="Chalmers">J. Chalmers</name><name sortKey="Colman, S" sort="Colman, S" uniqKey="Colman S" first="S." last="Colman">S. Colman</name><name sortKey="Davis, S" sort="Davis, S" uniqKey="Davis S" first="S." last="Davis">S. Davis</name><name sortKey="Donnan, G" sort="Donnan, G" uniqKey="Donnan G" first="G." last="Donnan">G. Donnan</name><name sortKey="Macmahon, S" sort="Macmahon, S" uniqKey="Macmahon S" first="S." last="Macmahon">S. Macmahon</name><name sortKey="Neal, B" sort="Neal, B" uniqKey="Neal B" first="B." last="Neal">B. Neal</name><name sortKey="Woodward, M" sort="Woodward, M" uniqKey="Woodward M" first="M." last="Woodward">M. Woodward</name></country><country name="Nouvelle-Zélande"><noRegion><name sortKey="Anderson, C" sort="Anderson, C" uniqKey="Anderson C" first="C." last="Anderson">C. Anderson</name></noRegion></country><country name="France"><region name="Île-de-France"><name sortKey="Bousser, M G" sort="Bousser, M G" uniqKey="Bousser M" first="M. G." last="Bousser">M. G. Bousser</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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