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Circulation. 2005;112:1525-1526
doi: 10.1161/CIRCULATIONAHA.105.566489
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(Circulation. 2005;112:1525-1526.)
© 2005 American Heart Association, Inc.

Editorial

Blood Pressure Lowering in PROGRESS (Perindopril Protection Against Recurrent Stroke Study) and White Matter Hyperintensities

Should This Progress Matter to Patients?

Ernesto L. Schiffrin, MD, PhD, FRCPC

From the Multidisciplinary Research Group on Hypertension, Clinical Research Institute of Montreal, and Division of Internal Medicine, Hôtel-Dieu Hospital of the University of Montreal Hospital Centre (CHUM), Montreal, Québec, Canada.

Correspondence to Ernesto L. Schiffrin, MD, PhD, FRCPC, Clinical Research Institute of Montreal, 110 Pine Ave West, Montreal, QC H2W 1R7, Canada. E-mail ernesto.schiffrin@ircm.qc.ca


Key Words: Editorials • cerebral ischemia • hypertension • prevention • imaging


An extract of the first 250 words of the full text is provided, because this article has no abstract.
 

Hypertension is the leading cause of stroke,1 a major catastrophe from a human, financial, and societal point of view. Blood pressure (BP) levels are also associated with cognitive impairment in older adults with vascular dementia and may contribute to the progression of Alzheimer disease.2–5 Indeed, hypertension induces a 2.3-fold increase in the risk of Alzheimer-type dementia.6 Control of BP may thus not only contribute to the prevention of stroke7 but also to slowing down the progression of cognitive impairment in hypertensive individuals.5,8 Interventional studies such as Systolic Hypertension in Europe (Syst-Eur) showed that control of high BP was followed by a significantly reduced incidence of stroke and by a decrease in the development of dementia of almost 50%.7 Using an angiotensin-converting enzyme (ACE) inhibitor in association with a diuretic in most patients, the PeRindopril prOtection aGainst Recurrent Stroke Study (PROGRESS) showed conclusively that BP lowering allows secondary prevention of stroke.9 Furthermore, during the mean follow-up period of 3.9 years, cognitive decline occurred in 9.1% of the 3051 randomized participants in the actively treated group and 11.0% of the 3054 randomized participants in the placebo group, a risk reduction of 19% (P=0.01).10 Risk of the composite outcomes of dementia with recurrent stroke and cognitive decline with recurrent stroke were reduced by 34% (P=0.03) and 45% (P<0.001), respectively, and interestingly, with no effect on dementia or cognitive decline in the absence of recurrent stroke. This has been confirmed to some degree by the Study on Cognition . . . [Full Text of this Article]


Related Article:

Effects of Blood Pressure Lowering on Cerebral White Matter Hyperintensities in Patients With Stroke: The PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy
Carole Dufouil, John Chalmers, Oguzhan Coskun, Véronique Besançon, Marie-Germaine Bousser, Pierre Guillon, Stephen MacMahon, Bernard Mazoyer, Bruce Neal, Mark Woodward, Nathalie Tzourio-Mazoyer, Christophe Tzourio for the PROGRESS MRI Substudy Investigators
Circulation 2005 112: 1644-1650. [Abstract] [Full Text]



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