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...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, placebocontrolled 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 i ndapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, causespecific vascular outcomes, and death from any cause. Results -There were 476 patient s 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 eve nt s and 34%(95%CI, -13 to 61) reduction in stroke. The benefits of blood pressu re-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hyperten sion (P homogeneity=0.4). Conclusions -For most patients with atrial fibrillati on, routine blood pressurelowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.展开更多
文摘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, placebocontrolled 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 i ndapamide for those without an indication for or a contraindication to a diuretic) or matching placebo(s). Outcomes are total major vascular events, causespecific vascular outcomes, and death from any cause. Results -There were 476 patient s 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 eve nt s and 34%(95%CI, -13 to 61) reduction in stroke. The benefits of blood pressu re-lowering in patients with atrial fibrillation were achieved irrespective of the use of anticoagulant therapy (P homogeneity=0.8) or the presence of hyperten sion (P homogeneity=0.4). Conclusions -For most patients with atrial fibrillati on, routine blood pressurelowering is likely to provide protection against major vascular events additional to that conferred by anticoagulation.
