Showing papers by "Bruce Neal published in 1997"
TL;DR: Questions about the safety of BP reduction for patients with preexisting cardiovascular disease have been raised following observations of J- and U-shaped associations between BP levels and the risks of recurrent myocardial infarction and stroke.
Abstract: Blood pressure (BP) levels are directly and continuously associated with the risks of both coronary heart disease and stroke in individuals without a history of major cardiovascular disease,1 and randomized trials in patients with hypertension have demonstrated that BP lowering reduces these risks after just a few years of beginning treatment.2 3 The proportional benefits of treatment appear to be similar in higher and lower risk patients, and the absolute benefits therefore increase with the level of absolute risk.3 This raises the possibility that patients at highest absolute risk of myocardial infarction or stroke, namely, those with established coronary or cerebrovascular disease, stand to benefit most from BP lowering.
However, questions about the safety of BP reduction for patients with preexisting cardiovascular disease have been raised following observations of J- and U-shaped associations between BP levels and the risks of recurrent myocardial infarction4 and stroke.5 Until recently, it has been unclear whether the J- and U-shaped associations resulted from low BP causing an increase in recurrent events or from more severe or unstable disease causing a decrease in BP and, independently, an increased risk of recurrence. If the latter were true, it could be hypothesized that the nonlinear associations would be most marked in the first few years of follow-up, when …
41 citations
TL;DR: The PROGRESS study as mentioned in this paper investigates whether blood pressure lowering with an angiotensin converting enzyme inhibitor-based regimen will reduce the risk of cognitive impairment in patients with a history of stroke or transient ischaemic attack.
Abstract: Cerebrovascular disease and high blood pressure both appear to increase the risk of vascular dementia. PROGRESS aims to investigate whether blood pressure lowering with an angiotensin converting enzyme inhibitor-based regimen will reduce the risk of cognitive impairment in patients with a history of stroke or transient ischaemic attack. A total of at least 6000 patients will be randomised to receive perindopril (± indapamide) or matching placebo(s), with treatment and follow-up scheduled to continue for at least 4 years. Substudies will investigate the effects of treatment on cognitive decline in subgroups defined by apo-E genotype and on white matter lesions assessed by magnetic resonance imaging. Final results from the study should be available in 2001.
24 citations