TY - JOUR
T1 - Effects of blood pressure lowering on intracranial and extracranial bleeding in patients on antithrombotic therapy
T2 - The PROGRESS trial
AU - Arima, Hisatomi
AU - Anderson, Craig
AU - Omae, Teruo
AU - Woodward, Mark
AU - MacMahon, Stephen
AU - Mancia, Giuseppe
AU - Bousser, Marie Germaine
AU - Tzourio, Christophe
AU - Rodgers, Anthony
AU - Neal, Bruce
AU - Chalmers, John
PY - 2012/6
Y1 - 2012/6
N2 - 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. Clinical Trial Registration INFORMATION-: This trial was not registered because patients were enrolled before July 1, 2005.
AB - 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. Clinical Trial Registration INFORMATION-: This trial was not registered because patients were enrolled before July 1, 2005.
KW - antihypertensive agents
KW - antithrombotics
KW - bleeding
KW - clinical trials
KW - hypertension
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U2 - 10.1161/STROKEAHA.112.651448
DO - 10.1161/STROKEAHA.112.651448
M3 - Article
C2 - 22535269
AN - SCOPUS:84861648567
VL - 43
SP - 1675
EP - 1677
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 6
ER -