Perindopril-based blood pressure-lowering reduces major vascular events in patients with atrial fibrillation and prior stroke or transient ischemic attack

Hisatomi Arima, Robert G. Hart, Sam Colman, John Chalmers, Craig Anderson, Anthony Rodgers, Mark Woodward, Stephen MacMahon, Bruce Neal

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose - Patients with atrial fibrillation have a high risk of stroke and other vascular events even if anticoagulated. The primary objective here is to determine whether routine blood pressure-lowering provides additional protection for this high-risk patient group. Methods - This study was a subsidiary analysis of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS)-a randomized, placebo-controlled trial that established the beneficial effects of blood pressure-lowering in a heterogeneous group of patients with cerebrovascular disease. A total of 6105 patients were randomly assigned to either active treatment (2 to 4 mg perindopril for all participants plus 2.0 to 2.5 mg indapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, cause-specific vascular outcomes, and death from any cause. Results - There were 476 patients with atrial fibrillation at baseline, of whom 51% were taking anticoagulants. In these patients, active treatment lowered mean blood pressure by 7.3/3.4 mm Hg and was associated with a 38% (95% confidence interval [CI], 6 to 59) reduction in major vascular events and 34% (95% CI, -13 to 61) reduction in stroke. The benefits of blood pressure-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hypertension (P homogeneity=0.4). Conclusions - For most patients with atrial fibrillation, routine blood pressure-lowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.

Original languageEnglish (US)
Pages (from-to)2164-2169
Number of pages6
JournalStroke
Volume36
Issue number10
DOIs
StatePublished - Oct 2005

Keywords

  • Antihypertensive agents
  • Atrial fibrillation
  • Randomized, controlled trials
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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