Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals The Perindopril Protection Against Recurrent Stroke Study Trial

Czernichow, Sebastien, Ninomiya, Toshiharu, Huxley, Rachel, Kengne, Andre-Pascal, Batty, G. David, Grobbee, Diederick E., Woodward, Mark, Neal, Bruce and Chalmers, John (2010) Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals The Perindopril Protection Against Recurrent Stroke Study Trial. Hypertension, 55 5: 1193-1198. doi:10.1161/HYPERTENSIONAHA.109.140624


Author Czernichow, Sebastien
Ninomiya, Toshiharu
Huxley, Rachel
Kengne, Andre-Pascal
Batty, G. David
Grobbee, Diederick E.
Woodward, Mark
Neal, Bruce
Chalmers, John
Title Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals The Perindopril Protection Against Recurrent Stroke Study Trial
Journal name Hypertension   Check publisher's open access policy
ISSN 0194-911X
1524-4563
Publication date 2010-05
Year available 2010
Sub-type Article (original research)
DOI 10.1161/HYPERTENSIONAHA.109.140624
Volume 55
Issue 5
Start page 1193
End page 1198
Total pages 6
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted 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 (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. 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 mm Hg (SE: 0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 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% CIs): 0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 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/m2; 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 5 years, active therapy prevented 1 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 indices 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.
Keyword Obesity
Blood pressure
Perindopril
Cardiovascular disease
Stroke
Randomized Controlled-Trials
American-Heart-Association
Body-Mass Index
Risk-Factors
Arterial-Hypertension
Scientific Statement
European-Society
Of-Cardiology
United-States
Disease
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Published online before print March 8, 2010.

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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