Impact of blood pressure lowering on cardiovascular outcomes in normal weight, overweight and obese individuals: the PROGRESS Trial
Identifieur interne : 001E37 ( Pmc/Curation ); précédent : 001E36; suivant : 001E38Impact of blood pressure lowering on cardiovascular outcomes in normal weight, overweight and obese individuals: the PROGRESS Trial
Auteurs : Sébastien Czernichow [Australie, France] ; Toshiharu Ninomiya [Australie] ; Rachel Huxley [Australie] ; André-Pascal Kengne [Australie] ; G David Batty [Australie, Royaume-Uni] ; Diederick E. Grobbee [Pays-Bas] ; Mark Woodward [Australie] ; Bruce Neal [Australie] ; John Chalmers [Australie]Source :
- Hypertension [ 0194-911X ] ; 2010.
Abstract
There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kg/m2) in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 (SE, 0.5/0.3) mmHg, with no difference by body mass index quarters: < 23.1, 23.1-25.3, 25.4-27.8 and ≥ 27.9 kg/m2. A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% confidence intervals): 0.80 (0.62-1.02), 0.78 (0.61-1.01), 0.67 (0.53-0.86), 0.69 (0.54-0.88) and 0.74 (0.66-0.84) (p for heterogeneity = 0.16). Similar results were apparent for stroke and stroke subtypes (all p for heterogeneity ≥ 0.07) or with the standard definitions of overweight and obesity (< 25, 25 to 29 and ≥ 30 kg/m) (all p for heterogeneity ≥ 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over five years, active therapy prevented one major vascular event among every 28, 23, 13 and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass index in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
Url:
DOI: 10.1161/HYPERTENSIONAHA.109.140624
PubMed: 20212271
PubMed Central: 4170774
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<front><div type="abstract" xml:lang="en"><p id="P1">There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kg/m<sup>2</sup>
) in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 (SE, 0.5/0.3) mmHg, with no difference by body mass index quarters: < 23.1, 23.1-25.3, 25.4-27.8 and ≥ 27.9 kg/m<sup>2</sup>
. A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% confidence intervals): 0.80 (0.62-1.02), 0.78 (0.61-1.01), 0.67 (0.53-0.86), 0.69 (0.54-0.88) and 0.74 (0.66-0.84) (p for heterogeneity = 0.16). Similar results were apparent for stroke and stroke subtypes (all p for heterogeneity ≥ 0.07) or with the standard definitions of overweight and obesity (< 25, 25 to 29 and ≥ 30 kg/m) (all p for heterogeneity ≥ 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over five years, active therapy prevented one major vascular event among every 28, 23, 13 and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass index in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.</p>
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<title-group><article-title>Impact of blood pressure lowering on cardiovascular outcomes in normal weight, overweight and obese individuals: the PROGRESS Trial</article-title>
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<contrib-group><contrib contrib-type="author"><name><surname>Czernichow</surname>
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<aff id="A1"><label>1</label>
George Institute for International Health, University of Sydney, Sydney, Australia</aff>
<aff id="A2"><label>2</label>
Department of Public Health, Avicenne Hospital; University of Paris 13, Bobigny, France</aff>
<aff id="A3"><label>3</label>
Medical Research Council, Social & Public Health Sciences Unit, Glasgow, UK</aff>
<aff id="A4"><label>4</label>
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands</aff>
<author-notes><corresp id="CR1"><bold>Corresponding author for reprint and request:</bold>
Assoc/Prof. Sébastien Czernichow Unité de Recherche en Epidémiologie Nutritionnelle Faculté de médecine SMBH. 74, rue Marcel Cachin, 93017 Bobigny, France Tel: +33 1 48 38 89 32, Fax: +33 1 48 38 89 31 <email>czernichow@uren.smbh.univ-paris13.fr</email>
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<pmc-comment>elocation-id from pubmed: 10.1161/HYPERTENSIONAHA.109.140624</pmc-comment>
<abstract><p id="P1">There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kg/m<sup>2</sup>
) in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 (SE, 0.5/0.3) mmHg, with no difference by body mass index quarters: < 23.1, 23.1-25.3, 25.4-27.8 and ≥ 27.9 kg/m<sup>2</sup>
. A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% confidence intervals): 0.80 (0.62-1.02), 0.78 (0.61-1.01), 0.67 (0.53-0.86), 0.69 (0.54-0.88) and 0.74 (0.66-0.84) (p for heterogeneity = 0.16). Similar results were apparent for stroke and stroke subtypes (all p for heterogeneity ≥ 0.07) or with the standard definitions of overweight and obesity (< 25, 25 to 29 and ≥ 30 kg/m) (all p for heterogeneity ≥ 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over five years, active therapy prevented one major vascular event among every 28, 23, 13 and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass index in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.</p>
</abstract>
<kwd-group><kwd>obesity</kwd>
<kwd>blood pressure</kwd>
<kwd>perindopril</kwd>
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<kwd>stroke</kwd>
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