Showing papers by "Bruce Neal published in 2007"
TL;DR: There are similar blood pressure-dependent effects of ACEI and ARB for the risks of stroke, CHD and heart failure and for ACEI, but not ARB, there is evidence ofBlood pressure-independent effects on the risk of major coronary disease events.
Abstract: Objectives To evaluate the blood pressure-dependent and independent effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on major cardiovascular events. Methods Using data from 26 large-scale trials comparing an ACEI or an ARB with placebo or another drug class, meta-regression analyses were conducted in which treatment-specific relative risks for major cause-specific outcomes [stroke, major coronary heart disease (CHD) events and heart failure] were regressed against follow-up blood pressure differences. Results From a total of 146 838 individuals with high blood pressure or an elevated risk of cardiovascular disease, 22 666 major cardiovascular events were documented during follow-up. The analyses showed comparable blood pressure-dependent reductions in risk with ACEI and ARB (P >or= 0.3 for all three outcomes). The analyses also showed that ACEI produced a blood pressure-independent reduction in the relative risk of CHD of approximately 9% (95% confidence interval 3-14%). No similar effect was detected for ARB, and there was some evidence of a difference between ACEI and ARB in this regard (P = 0.002). For both stroke and heart failure there was no evidence of any blood pressure-independent effects of either ACEI or ARB. Conclusion There are similar blood pressure-dependent effects of ACEI and ARB for the risks of stroke, CHD and heart failure. For ACEI, but not ARB, there is evidence of blood pressure-independent effects on the risk of major coronary disease events.
355 citations
TL;DR: Salt substitution produced a substantial and sustained systolic blood pressure reduction in this population, and should be actively promoted as a low-cost alternate or adjunct to drug therapy for people consuming significant quantities of salt.
Abstract: OBJECTIVE: Dietary sodium and potassium consumption is associated with blood pressure levels. The objective of this study was to define a practical and low-cost method for the control of blood pressure by modification of these dietary cations in rural Chinese. METHODS: This study was a double-blind, randomized, controlled trial designed to establish the long-term effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulphate) compared to normal salt (100% sodium chloride) on blood pressure among high-risk individuals. Following a 4-week run-in period on salt substitute, participants were randomly assigned to replace their household salt with either the study salt substitute or normal salt for a 12-month period. RESULTS: The mean age of the 608 randomized participants was 60 years and 56% of them were female. Sixty-four percent had a history of vascular disease and 61% were taking one or more blood pressure-lowering drugs at entry. Mean baseline blood pressure was 159/93 mmHg (SD 26/14). The mean overall difference in systolic blood pressure between randomized groups was 3.7 mmHg (95% confidence interval 1.6-5.9, P < 0.001). There was strong evidence that the magnitude of this reduction increased over time (P = 0.001) with the maximum net reduction of 5.4 mmHg (2.3-8.5) achieved at 12 months. There were no detectable effects on diastolic blood pressure. CONCLUSION: Salt substitution produced a substantial and sustained systolic blood pressure reduction in this population, and should be actively promoted as a low-cost alternate or adjunct to drug therapy for people consuming significant quantities of salt.
113 citations
01 Jan 2007
TL;DR: In this article, a double-blind, randomized, controlled trial was designed to establish the long-term effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulphate) compared to normal salt (100% salt) on blood pressure among high-risk individuals.
Abstract: Objective Dietary sodium and potassium consumption is associated with blood pressure levels. The objective of this study was to define a practical and low-cost method for the control of blood pressure by modification of these dietary cations in rural Chinese. Methods This study was a double-blind, randomized, controlled trial designed to establish the long-term effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulphate) compared to normal salt (100% sodium chloride) on blood pressure among high-risk individuals. Following a 4-week run-in period on salt substitute, participants were randomly assigned to replace their household salt with either the study salt substitute or normal salt for a 12-month period. Results The mean age of the 608 randomized participants was 60 years and 56% of them were female. Sixty-four percent had a history of vascular disease and 61% were taking one or more blood pressure-lowering drugs at entry. Mean baseline blood pressure was 159/93 mmHg (SD 26/14). The mean overall difference in systolic blood pressure between randomized groups was 3.7 mmHg (95% confidence interval 1.6–5.9, P < 0.001). There was strong evidence that the magnitude of this reduction increased over time (P = 0.001) with the maximum net reduction of 5.4 mmHg (2.3–8.5) achieved at 12 months. There were no detectable effects on diastolic blood pressure. Conclusion Salt substitution produced a substantial and sustained systolic blood pressure reduction in this population, and should be actively promoted as a low-cost alternate or adjunct to drug therapy for people consuming significant quantities of salt.
98 citations
TL;DR: The perindopril-based treatment reduced the risk of major vascular events by 30% and stroke by 35% among subjects with chronic kidney disease, and the absolute effects of treatment were 1.7-fold greater for those with CKD than for those without as discussed by the authors.
Abstract: Chronic kidney disease (CKD) is associated with a high risk of cardiovascular disease, but evidence regarding the effectiveness of interventions to reduce that risk is lacking. The Perindopril Protection against Recurrent Stroke Study (PROGRESS) study enrolled 6105 participants with cerebrovascular disease and randomly allocated them to perindopril-based blood pressure–lowering therapy or placebo. Individuals with CKD were at approximately 1.5-fold greater risk of major vascular events, stroke, and coronary heart disease, and were more than twice as likely to die (all P0.002). Perindopril-based treatment reduced the risk of major vascular events by 30% and stroke by 35% among subjects with CKD, and the absolute effects of treatment were 1.7-fold greater for those with CKD than for those without. Considering patients with CKD and a history of cerebrovascular disease, perindopril prevented one stroke or other cardiovascular event among every 11 patients treated over five years. In conclusion, kidney function should be considered when determining the need for blood pressure lowering therapy in patients with cerebrovascular disease.
98 citations
TL;DR: The possibility of increasing cardiovascular risk factors and prevalence of vascular disease in areas of rural India represent a public health concern and larger and repeated epidemiological studies focusing on chronic diseases are required to inform treatment and prevention strategies suitable for use in these areas and other resource poor settings.
92 citations
TL;DR: In this paper, the authors evaluated the effects of communication between the central trial coordinators and the clinical sites in the setting of a large international multi-centre clinical trial and found that the additional communication strategy may be of some incremental benefit in helping sites achieve recruitment targets sooner.
27 citations
TL;DR: The consumption of plant sterol-enriched milk tea decreased cholesterol concentrations although to a lesser extent than was anticipated, and the reason for reduced efficacy is unclear but may be attributable to the novel food format used or the Chinese population studied.
Abstract: The cholesterol-lowering effects of plant sterols in a format suitable for use in China have not previously been investigated. We conducted the study to quantify in adult Chinese the effects on blood lipid concentrations of a plant sterol-enriched milk tea powder. The study was a double-blind, randomised trial in which 309 participants were randomised to receive daily 2.3 or 1.5 g plant sterol supplementation or placebo for 5 weeks. The milk tea was consumed with the two fattiest meals of the day with half the assigned daily dose taken on each occasion. Fasting venous blood samples were collected before commencement and upon completion of randomised treatment. The mean age of study participants was 44 years, 62% were female and 62% had a history of hypercholesterolaemia. Baseline mean total cholesterol was 5.5 mmol/l and LDL-cholesterol was 3.2 mmol/l. Compared with placebo, the 2.3 g/d plant sterol dose reduced total cholesterol by 0.25 (95% CI 0.07, 0.43) mmol/l (P = 0.01) and the 1.5 g/d dose by 0.23 (95% CI 0.06, 0.41) mmol/l (P = 0.01). For LDL-cholesterol the corresponding reductions were 0.17 (95% CI 0.00, 0.35) mmol/l (P = 0.06) and 0.15 (95% CI -0.02, 0.32) mmol/l (P = 0.08). For neither outcome was there evidence of differences between the effects of the two doses (both P values >0.4). In conclusion, the consumption of plant sterol-enriched milk tea decreased cholesterol concentrations although to a lesser extent than was anticipated. The reason for reduced efficacy is unclear but may be attributable to the novel food format used or the Chinese population studied.
16 citations
TL;DR: SBP predicted ICHrisk in subjects with cerebrovascular disease, whereas CRP, sVCAM-1, homocysteine, NT-proBNP, and renin did not predict ICH risk, and trends for prediction of ICH Risk by mean LDL particle diameter and large LDL particle concentration are hypothesis generating and require confirmation in larger studies.
Abstract: BackgroundOnly limited data are available for risk factors for intracerebral haemorrhage (ICH) in subjects with established cerebrovascular disease.DesignWe performed a nested case-control study of participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS). This was a randomized, placebo-controlled trial that established the beneficial effects of blood pressure lowering in 6105 patients with cerebrovascular disease.MethodsEach of 41 subjects who experienced ICH during a mean follow-up of 3.9 years was matched to 1-3 control subjects. Lipoprotein particles and other plasma markers were measured in baseline blood samples from PROGRESS participants.ResultsIn comparison with control subjects, ICH cases had increased mean low-density lipoprotein (LDL) diameter (P=0.04) and increased large LDL particle concentration (P=0.03). The odds ratio (adjusted for regression dilution bias) for ICH risk with 10 mmHg increase in systolic blood pressure (SBP) was 1.45 (95% confidence interval: 1.01...
9 citations
TL;DR: It is concluded that plasma NT-proBNP level, in addition to predicting cardiovascular risk, may provide a measure of risk reduction by blood pressure-lowering therapy.
Abstract: ObjectiveThe plasma amino-terminal-pro-B-type natriuretic peptide (NT-proBNP) level predicted congestive heart failure, myocardial infarction, and ischaemic stroke in participants of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a placebo-controlled study of the effects of bl
8 citations
Journal Article•