Effects of perindopril-based blood pressure lowering and of patient characteristics on the progression of silent brain infarct: The perindopril protection against recurrent stroke study (PROGRESS) CT substudy in Japan

Yasuhiro Hasegawa, Takenori Yamaguchi, Teruo Omae, Mark Woodward, John Chalmers, M. Takasaki, T. Iwamoto, H. Tohgi, H. Takahashi, S. Konno, S. Uchiyama, Y. Kimura, I. Hayakawa, T. Miyamori, T. Ishitsuka, O. Shiokawa, M. Nakano, T. Takenoyama, K. Fukiyama, H. MurataniG. Hirose, S. Kataoka, F. Sakai, T. Kanda, Y. Kitagawa, M. Yoshitoshi, Y. Shinohara, S. Takizawa, S. Kazabari, B. Mihara, Y. Kawagishi, H. Makishita, K. Isomura, K. Tabata, S. Nakagawa, H. Okada, A. Takeda, K. Nakajima, M. Makino, Y. Hirata, Y. Watahiki, J. Kawamura, N. Yoshikawa, K. Takastuka, I. Akiguchi, H. Wakita, H. Tomimoto, S. Nakamura, T. Kohriyama, K. Hiwada, Y. Shigematsu, T. Yanagihara, M. Matsumoto, H. Ueda, K. Nishimaru, K. Setsu, S. Kobayashi, S. Yamaguchi, S. Hashimoto, M. Nakamura, S. Mitake, M. Uchida, N. Ishihara, N. Imai, M. Imaizumi, Y. Hokezu, M. Satake

Research output: Contribution to journalArticle

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Abstract

Controversy persists as to whether reducing the blood pressure of patients with a history of stroke leads to an increased risk of silent brain infarct (SBI) and dementia. A total of 667 patients were randomized to receive the angiotensin-converting enzyme (ACE) inhibitor perindopril (4 mg daily), with or without the diuretic indapamide (2 mg daily) or matching placebo(s). Brain CT scanning was performed annually over the mean follow-up period of 3.9 years. Active treatment reduced the blood pressure (systolic/diastolic) by 5.2/2.6 mmHg over the follow-up period. A total of 119 new SBI were detected and 92% of them were lacunar type small infarcts. The frequency of reaching the primary end-point (recurrent symptomatic stroke or new SBI) was similar in the placebo group (26.5%) and in the active treatment group (25.9%). There was no significant difference in brain atrophy indices between two groups. In the subgroup with a history of large artery infarction, 7 out of 55 patients from the placebo group developed new SBI, while none of the 40 patients from the active treatment group did so (p=0.020). The baseline diastolic blood pressure was significantly associated with the risk of new SBI (p=0.004), but the stroke subtype was not. In conclusion, blood pressure-lowering with a perindopril-based regimen did not increase the risk of SBI and brain atrophy in patients with a history of stroke. The baseline diastolic blood pressure was an independent predictor of new SBI, but the index stroke subtype did not influence the risk of SBI.

Original languageEnglish
Pages (from-to)147-156
Number of pages10
JournalHypertension Research
Volume27
Issue number3
DOIs
Publication statusPublished - 01-03-2004

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Perindopril
Japan
Stroke
Blood Pressure
Brain
Placebos
Atrophy
Indapamide
Lacunar Stroke
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Infarction
Dementia
Therapeutics
Arteries

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Hasegawa, Yasuhiro ; Yamaguchi, Takenori ; Omae, Teruo ; Woodward, Mark ; Chalmers, John ; Takasaki, M. ; Iwamoto, T. ; Tohgi, H. ; Takahashi, H. ; Konno, S. ; Uchiyama, S. ; Kimura, Y. ; Hayakawa, I. ; Miyamori, T. ; Ishitsuka, T. ; Shiokawa, O. ; Nakano, M. ; Takenoyama, T. ; Fukiyama, K. ; Muratani, H. ; Hirose, G. ; Kataoka, S. ; Sakai, F. ; Kanda, T. ; Kitagawa, Y. ; Yoshitoshi, M. ; Shinohara, Y. ; Takizawa, S. ; Kazabari, S. ; Mihara, B. ; Kawagishi, Y. ; Makishita, H. ; Isomura, K. ; Tabata, K. ; Nakagawa, S. ; Okada, H. ; Takeda, A. ; Nakajima, K. ; Makino, M. ; Hirata, Y. ; Watahiki, Y. ; Kawamura, J. ; Yoshikawa, N. ; Takastuka, K. ; Akiguchi, I. ; Wakita, H. ; Tomimoto, H. ; Nakamura, S. ; Kohriyama, T. ; Hiwada, K. ; Shigematsu, Y. ; Yanagihara, T. ; Matsumoto, M. ; Ueda, H. ; Nishimaru, K. ; Setsu, K. ; Kobayashi, S. ; Yamaguchi, S. ; Hashimoto, S. ; Nakamura, M. ; Mitake, S. ; Uchida, M. ; Ishihara, N. ; Imai, N. ; Imaizumi, M. ; Hokezu, Y. ; Satake, M. / Effects of perindopril-based blood pressure lowering and of patient characteristics on the progression of silent brain infarct : The perindopril protection against recurrent stroke study (PROGRESS) CT substudy in Japan. In: Hypertension Research. 2004 ; Vol. 27, No. 3. pp. 147-156.
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abstract = "Controversy persists as to whether reducing the blood pressure of patients with a history of stroke leads to an increased risk of silent brain infarct (SBI) and dementia. A total of 667 patients were randomized to receive the angiotensin-converting enzyme (ACE) inhibitor perindopril (4 mg daily), with or without the diuretic indapamide (2 mg daily) or matching placebo(s). Brain CT scanning was performed annually over the mean follow-up period of 3.9 years. Active treatment reduced the blood pressure (systolic/diastolic) by 5.2/2.6 mmHg over the follow-up period. A total of 119 new SBI were detected and 92{\%} of them were lacunar type small infarcts. The frequency of reaching the primary end-point (recurrent symptomatic stroke or new SBI) was similar in the placebo group (26.5{\%}) and in the active treatment group (25.9{\%}). There was no significant difference in brain atrophy indices between two groups. In the subgroup with a history of large artery infarction, 7 out of 55 patients from the placebo group developed new SBI, while none of the 40 patients from the active treatment group did so (p=0.020). The baseline diastolic blood pressure was significantly associated with the risk of new SBI (p=0.004), but the stroke subtype was not. In conclusion, blood pressure-lowering with a perindopril-based regimen did not increase the risk of SBI and brain atrophy in patients with a history of stroke. The baseline diastolic blood pressure was an independent predictor of new SBI, but the index stroke subtype did not influence the risk of SBI.",
author = "Yasuhiro Hasegawa and Takenori Yamaguchi and Teruo Omae and Mark Woodward and John Chalmers and M. Takasaki and T. Iwamoto and H. Tohgi and H. Takahashi and S. Konno and S. Uchiyama and Y. Kimura and I. Hayakawa and T. Miyamori and T. Ishitsuka and O. Shiokawa and M. Nakano and T. Takenoyama and K. Fukiyama and H. Muratani and G. Hirose and S. Kataoka and F. Sakai and T. Kanda and Y. Kitagawa and M. Yoshitoshi and Y. Shinohara and S. Takizawa and S. Kazabari and B. Mihara and Y. Kawagishi and H. Makishita and K. Isomura and K. Tabata and S. Nakagawa and H. Okada and A. Takeda and K. Nakajima and M. Makino and Y. Hirata and Y. Watahiki and J. Kawamura and N. Yoshikawa and K. Takastuka and I. Akiguchi and H. Wakita and H. Tomimoto and S. Nakamura and T. Kohriyama and K. Hiwada and Y. Shigematsu and T. Yanagihara and M. Matsumoto and H. Ueda and K. Nishimaru and K. Setsu and S. Kobayashi and S. Yamaguchi and S. Hashimoto and M. Nakamura and S. Mitake and M. Uchida and N. Ishihara and N. Imai and M. Imaizumi and Y. Hokezu and M. Satake",
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Hasegawa, Y, Yamaguchi, T, Omae, T, Woodward, M, Chalmers, J, Takasaki, M, Iwamoto, T, Tohgi, H, Takahashi, H, Konno, S, Uchiyama, S, Kimura, Y, Hayakawa, I, Miyamori, T, Ishitsuka, T, Shiokawa, O, Nakano, M, Takenoyama, T, Fukiyama, K, Muratani, H, Hirose, G, Kataoka, S, Sakai, F, Kanda, T, Kitagawa, Y, Yoshitoshi, M, Shinohara, Y, Takizawa, S, Kazabari, S, Mihara, B, Kawagishi, Y, Makishita, H, Isomura, K, Tabata, K, Nakagawa, S, Okada, H, Takeda, A, Nakajima, K, Makino, M, Hirata, Y, Watahiki, Y, Kawamura, J, Yoshikawa, N, Takastuka, K, Akiguchi, I, Wakita, H, Tomimoto, H, Nakamura, S, Kohriyama, T, Hiwada, K, Shigematsu, Y, Yanagihara, T, Matsumoto, M, Ueda, H, Nishimaru, K, Setsu, K, Kobayashi, S, Yamaguchi, S, Hashimoto, S, Nakamura, M, Mitake, S, Uchida, M, Ishihara, N, Imai, N, Imaizumi, M, Hokezu, Y & Satake, M 2004, 'Effects of perindopril-based blood pressure lowering and of patient characteristics on the progression of silent brain infarct: The perindopril protection against recurrent stroke study (PROGRESS) CT substudy in Japan', Hypertension Research, vol. 27, no. 3, pp. 147-156. https://doi.org/10.1291/hypres.27.147

Effects of perindopril-based blood pressure lowering and of patient characteristics on the progression of silent brain infarct : The perindopril protection against recurrent stroke study (PROGRESS) CT substudy in Japan. / Hasegawa, Yasuhiro; Yamaguchi, Takenori; Omae, Teruo; Woodward, Mark; Chalmers, John; Takasaki, M.; Iwamoto, T.; Tohgi, H.; Takahashi, H.; Konno, S.; Uchiyama, S.; Kimura, Y.; Hayakawa, I.; Miyamori, T.; Ishitsuka, T.; Shiokawa, O.; Nakano, M.; Takenoyama, T.; Fukiyama, K.; Muratani, H.; Hirose, G.; Kataoka, S.; Sakai, F.; Kanda, T.; Kitagawa, Y.; Yoshitoshi, M.; Shinohara, Y.; Takizawa, S.; Kazabari, S.; Mihara, B.; Kawagishi, Y.; Makishita, H.; Isomura, K.; Tabata, K.; Nakagawa, S.; Okada, H.; Takeda, A.; Nakajima, K.; Makino, M.; Hirata, Y.; Watahiki, Y.; Kawamura, J.; Yoshikawa, N.; Takastuka, K.; Akiguchi, I.; Wakita, H.; Tomimoto, H.; Nakamura, S.; Kohriyama, T.; Hiwada, K.; Shigematsu, Y.; Yanagihara, T.; Matsumoto, M.; Ueda, H.; Nishimaru, K.; Setsu, K.; Kobayashi, S.; Yamaguchi, S.; Hashimoto, S.; Nakamura, M.; Mitake, S.; Uchida, M.; Ishihara, N.; Imai, N.; Imaizumi, M.; Hokezu, Y.; Satake, M.

In: Hypertension Research, Vol. 27, No. 3, 01.03.2004, p. 147-156.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effects of perindopril-based blood pressure lowering and of patient characteristics on the progression of silent brain infarct

T2 - The perindopril protection against recurrent stroke study (PROGRESS) CT substudy in Japan

AU - Hasegawa, Yasuhiro

AU - Yamaguchi, Takenori

AU - Omae, Teruo

AU - Woodward, Mark

AU - Chalmers, John

AU - Takasaki, M.

AU - Iwamoto, T.

AU - Tohgi, H.

AU - Takahashi, H.

AU - Konno, S.

AU - Uchiyama, S.

AU - Kimura, Y.

AU - Hayakawa, I.

AU - Miyamori, T.

AU - Ishitsuka, T.

AU - Shiokawa, O.

AU - Nakano, M.

AU - Takenoyama, T.

AU - Fukiyama, K.

AU - Muratani, H.

AU - Hirose, G.

AU - Kataoka, S.

AU - Sakai, F.

AU - Kanda, T.

AU - Kitagawa, Y.

AU - Yoshitoshi, M.

AU - Shinohara, Y.

AU - Takizawa, S.

AU - Kazabari, S.

AU - Mihara, B.

AU - Kawagishi, Y.

AU - Makishita, H.

AU - Isomura, K.

AU - Tabata, K.

AU - Nakagawa, S.

AU - Okada, H.

AU - Takeda, A.

AU - Nakajima, K.

AU - Makino, M.

AU - Hirata, Y.

AU - Watahiki, Y.

AU - Kawamura, J.

AU - Yoshikawa, N.

AU - Takastuka, K.

AU - Akiguchi, I.

AU - Wakita, H.

AU - Tomimoto, H.

AU - Nakamura, S.

AU - Kohriyama, T.

AU - Hiwada, K.

AU - Shigematsu, Y.

AU - Yanagihara, T.

AU - Matsumoto, M.

AU - Ueda, H.

AU - Nishimaru, K.

AU - Setsu, K.

AU - Kobayashi, S.

AU - Yamaguchi, S.

AU - Hashimoto, S.

AU - Nakamura, M.

AU - Mitake, S.

AU - Uchida, M.

AU - Ishihara, N.

AU - Imai, N.

AU - Imaizumi, M.

AU - Hokezu, Y.

AU - Satake, M.

PY - 2004/3/1

Y1 - 2004/3/1

N2 - Controversy persists as to whether reducing the blood pressure of patients with a history of stroke leads to an increased risk of silent brain infarct (SBI) and dementia. A total of 667 patients were randomized to receive the angiotensin-converting enzyme (ACE) inhibitor perindopril (4 mg daily), with or without the diuretic indapamide (2 mg daily) or matching placebo(s). Brain CT scanning was performed annually over the mean follow-up period of 3.9 years. Active treatment reduced the blood pressure (systolic/diastolic) by 5.2/2.6 mmHg over the follow-up period. A total of 119 new SBI were detected and 92% of them were lacunar type small infarcts. The frequency of reaching the primary end-point (recurrent symptomatic stroke or new SBI) was similar in the placebo group (26.5%) and in the active treatment group (25.9%). There was no significant difference in brain atrophy indices between two groups. In the subgroup with a history of large artery infarction, 7 out of 55 patients from the placebo group developed new SBI, while none of the 40 patients from the active treatment group did so (p=0.020). The baseline diastolic blood pressure was significantly associated with the risk of new SBI (p=0.004), but the stroke subtype was not. In conclusion, blood pressure-lowering with a perindopril-based regimen did not increase the risk of SBI and brain atrophy in patients with a history of stroke. The baseline diastolic blood pressure was an independent predictor of new SBI, but the index stroke subtype did not influence the risk of SBI.

AB - Controversy persists as to whether reducing the blood pressure of patients with a history of stroke leads to an increased risk of silent brain infarct (SBI) and dementia. A total of 667 patients were randomized to receive the angiotensin-converting enzyme (ACE) inhibitor perindopril (4 mg daily), with or without the diuretic indapamide (2 mg daily) or matching placebo(s). Brain CT scanning was performed annually over the mean follow-up period of 3.9 years. Active treatment reduced the blood pressure (systolic/diastolic) by 5.2/2.6 mmHg over the follow-up period. A total of 119 new SBI were detected and 92% of them were lacunar type small infarcts. The frequency of reaching the primary end-point (recurrent symptomatic stroke or new SBI) was similar in the placebo group (26.5%) and in the active treatment group (25.9%). There was no significant difference in brain atrophy indices between two groups. In the subgroup with a history of large artery infarction, 7 out of 55 patients from the placebo group developed new SBI, while none of the 40 patients from the active treatment group did so (p=0.020). The baseline diastolic blood pressure was significantly associated with the risk of new SBI (p=0.004), but the stroke subtype was not. In conclusion, blood pressure-lowering with a perindopril-based regimen did not increase the risk of SBI and brain atrophy in patients with a history of stroke. The baseline diastolic blood pressure was an independent predictor of new SBI, but the index stroke subtype did not influence the risk of SBI.

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