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Biomedical subjects

John Chalmers

Publications and source records attributed to John Chalmers.

34 records · Page 2Linked to original sources
PubMed2003

Trials on blood pressure-lowering and secondary stroke prevention.

The risk of stroke is strongly and persistently related to the usual level of both systolic blood pressure (SBP) and diastolic blood pressure (DBP). This relation holds for primary and secondary stroke, both ischemic and hemorrhagic. The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) has now provided definitive evidence that lowering the blood pressure of patients with preexisting cerebrovascular disease (prior stroke or transient ischemic attack [TIA]) also reduces the incidence of secondary stroke. PROGRESS showed that a flexible blood pressure-lowering regimen involving an angiotensin-converting enzyme inhibitor (perindopril) and a diuretic (indapamide) reduces the incidence of stroke, major coronary events, and major vascular events by 28%, 26%, and 26%, respectively. These benefits were associated with an average reduction of 9.0 mm Hg (SBP) and 4.0 mm Hg (DBP). The 28% reduction in stroke incidence translated into a 24% reduction in ischemic stroke and a 50% reduction in hemorrhagic stroke. Combination therapy with perindopril and indapamide decreased blood pressure more effectively than did perindopril monotherapy (mean reduction of 12.3 mm Hg [SBP] and 5.0 mm Hg [DBP] vs 4.9 mm Hg [SBP] and 2.8 mm Hg [DBP], respectively) and was equally effective in reducing stroke risk in patients with and without hypertension. In conclusion, blood pressure-lowering therapy is now established as the most important measure for primary and secondary stroke prevention. Results of PROGRESS suggest that antihypertensive treatment with a combination of perindopril plus indapamide should now be routinely considered for all patients with previous stroke or TIA.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2003

Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease.

BACKGROUND: High blood pressure and stroke are associated with increased risks of dementia and cognitive impairment. This study aimed to determine whether blood pressure lowering would reduce the risks of dementia and cognitive decline among individuals with cerebrovascular disease. METHODS: The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a randomized, double-blind, placebo-controlled trial conducted among 6105 people with prior stroke or transient ischemic attack. Participants were assigned to either active treatment (perindopril for all participants and indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). The primary outcomes for these analyses were dementia (using DSM-IV criteria) and cognitive decline (a decline of 3 or more points in the Mini-Mental State Examination score). RESULTS: During a mean follow-up of 3.9 years, dementia was documented in 193 (6.3%) of the 3051 randomized participants in the actively treated group and 217 (7.1%) of the 3054 randomized participants in the placebo group (relative risk reduction, 12% [95% confidence interval, -8% to 28%]; P =.2). Cognitive decline occurred in 9.1% of the actively treated group and 11.0% of the placebo group (risk reduction, 19% [95% confidence interval, 4% to 32%]; P =.01). The risks of the composite outcomes of dementia with recurrent stroke and of cognitive decline with recurrent stroke were reduced by 34% (95% confidence interval, 3% to 55%) (P =.03) and 45% (95% confidence interval, 21% to 61%) (P<.001), respectively, with no clear effect on either dementia or cognitive decline in the absence of recurrent stroke. CONCLUSIONS: Active treatment was associated with reduced risks of dementia and cognitive decline associated with recurrent stroke. These findings further support the recommendation that blood pressure lowering with perindopril and indapamide therapy be considered for all patients with cerebrovascular disease.

Aged↗
PubMed2003

Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS): interpretation and implementation.

OBJECTIVES: To determine the effects of a perindopril-based blood pressure lowering regimen in hypertensive and non-hypertensive patients with a history of stroke or transient ischaemic attack (TIA). DESIGN AND METHODS: 6105 subjects from 172 centres in Asia, Australasia, and Europe were randomised to receive active treatment (n = 3051) or placebo (n = 3054). Active treatment consisted of a flexible regimen based on the angiotensin-converting enzyme inhibitor perindopril (4 mg daily), with the addition of the diuretic indapamide, at the discretion of treating physicians. The primary outcome was total stroke (fatal or non-fatal). Analysis was by intention to treat. RESULTS: Active treatment reduced blood pressure by 9/4 mmHg over 4 years of follow-up. 307 (10%) individuals assigned active treatment suffered a stroke, compared with 420 (14%) assigned placebo [relative risk reduction 28% (95% confidence interval 17-38), P < 0.0001]. Active treatment also reduced the risks of total major vascular events [26% (16-34)] including non-fatal myocardial infarction [38% (14-55)], severe cognitive decline [19% (4-32)], stroke-related dementia [34% (3-55)] and disability [18% (8-28)]. There were similar reductions in the risk of stroke in hypertensive and non-hypertensive subgroups (P < 0.01). Combination therapy with perindopril plus indapamide lowered blood pressure by 12/5 mmHg and stroke risk by 43%. Single-drug therapy lowered blood pressure by 5/3 mmHg and produced no significant fall in the risk of stroke. CONCLUSIONS: The blood-pressure lowering regimen used in Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) reduced the risks of stroke and other serious events in hypertensive and non-hypertensive subjects with a history of stroke (whatever the subtype) or transient ischaemic attack. Combination therapy with perindopril and indapamide produced larger blood pressure reductions and larger stroke reductions than monotherapy with perindopril alone. Treatment with these two agents should be considered routinely for all patients with a history of previous stroke or TIA, whether hypertensive or normotensive.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2003

International Society of Hypertension (ISH): statement on the management of blood pressure in acute stroke.

The ISH statement on the management of blood pressure in acute stroke was finalized after presentation and discussion at the World Health Organization and International Society of Hypertension (WHO-ISH) Meeting on Stroke and Blood Pressure, held in Melbourne, Australia, 5-7 December 2002. The meeting was conducted under the auspices of the Austin Hospital Medical Research Foundation, Melbourne.

Acute Disease↗
PubMed2003

International Society of Hypertension (ISH): statement on blood pressure lowering and stroke prevention.

The ISH Statement on blood pressure lowering and stroke prevention was finalized after presentation and discussion at the World Health Organization and International Society of Hypertension (WHO-ISH) Meeting on Stroke and Blood Pressure, held in Melbourne Australia, 5-7 December 2002. The meeting was conducted under the auspice of the Austin Hospital Medical Research Foundation, Melbourne.

Anticoagulants↗
PubMed2003

Diabetes and vascular disease: a new international trial.

The prevalence of diabetes is increasing, particularly in developing regions of the world. The social and economic consequences of this disease and its complications are enormous. We discuss the scope and implications of the increasing burden of diabetes and describe the rationale and design of a new international study examining blood pressure lowering and glucose control interventions aimed at reducing the risk of vascular complications in people with type 2 diabetes. This study is the first large-scale randomized trial in diabetes to include participants from both lower- and higher-income regions of the world.

Antihypertensive Agents↗
PubMed2003

[ADVANCE study: objectives, design and current status].

UNLABELLED: Patients with type 2 diabetes mellitus have markedly increased risks of developing vascular diseases. These risks are reduced by lowering blood pressure in hypertensive individuals. However, the association between blood pressure and vascular risk appears continuous, with no clearly defined blood pressure level below which the risks fail to further decline. Intensive glucose lowering in these patients has also been shown to reduce microvascular disease, but effects on macrovascular disease remain uncertain. OBJECTIVES: ADVANCE (Action in Diabetes and Vascular disease; preterAx and diamicroN-MR Controlled Evaluation) will examine the hypotheses that intensive blood pressure lowering (with an angiotensin-converting enzyme [ACE] inhibitor-diuretic combination) and glucose control in high-risk hypertensive or non-hypertensive individuals with type 2 diabetes reduce the incidence of vascular diseases. The study will also provide an opportunity to examine the effects of blood pressure lowering against a background of ACE inhibition among such patients. DESIGN: This 2 x 2 factorial randomised controlled trial will recruit 10 000 adults with type 2 diabetes at elevated risk of vascular disease, from approximately 200 clinical centres in 20 countries worldwide. Eligible patients are randomised to, first, the fixed combination of perindopril 2mg/indapamide 0.625 mg then perindopril 4 mg/indapamide 1.25mg or matching placebo, and, second, to an intensive sulphonylurea-based glucose control regimen (target glycosylated haemoglobin [HbA(1c)] </= 6.5%), or usual guidelines-based therapy. Any participant in whom ACE inhibition is thought to be indicated is provided with background perindopril therapy. The scheduled period of treatment and follow-up is 4.5 years. Primary outcomes are a composite of macrovascular and a composite of microvascular events. CURRENT STATUS: By mid-September 2002, more than 8000 patients had been recruited from 17 countries, with registrations expected to be completed by December 2002. Approximately half the participants recruited will be from Asia or from Eastern Europe. Final results are expected early in 2007. (Author's note: registration closed on January 24, 2003, with sufficient participants to exceed the target of 10 000 randomised subjects.)

Adult↗
PubMedDate not supplied

Comparison of various blood pressure lowering treatments on the primary prevention of cardiovascular outcomes in recent randomised clinical trials.

Randomised clinical trials completed over the past 8 to 10 years have provided much new evidence regarding the cardiovascular risks and benefits of treatment with newer blood pressure lowering drugs, particularly ACE inhibitors and calcium channel blockers (CCB). Trials of active treatment against placebo have now established that ACE inhibitors and CCBs reduce the risk of coronary heat disease and stroke in subjects with elevated blood pressure and that ACE inhibitors reduce the risk of heart failure but calcium antagonists do not. Clinical trials comparing active treatment regimens based on different blood pressure lowering drug classes, have provided convincing evidence that ACE inhibitors, CCBs, and "conventional treatment" with diuretics/beta-blockers are equally effective in the primary prevention of coronary heart disease, but that minor differences of the order of 5-12% favouring calcium antagonists may exist. The one area with a major difference is again for the primary prevention of heart failure where calcium antagonists are clearly inferior to diuretics/ beta-blockers and to ACE inhibitors. There is now convincing evidence that blood pressure lowering is effective in the secondary prevention of cardiovascular outcomes in subjects with established coronary heart disease, cerebrovascular disease, diabetes and chronic kidney disease, especially diabetic nephropathy. Clinical trial evidence comprising regimens based on different drug classes for the secondary prevention of cardiovascular outcomes is still very limited. It is possible that longer differences will be found between the efficacy and safety of drugs in secondary prevention than have been reported so far in primary prevention.

Antihypertensive Agents↗
PubMedDate not supplied

World health organisation-international society of hypertension (WHO/ISH) hypertension guidelines.

Hypertension is now recognised as a very major contributor to disease burden globally. The close working relationship between the World Health Organisation (WHO) and the International Society of Hypertension (ISH) has existed for several decades and led to the production of a number of guidelines and statements. Since the publication of the 1999 WHO/ISH Guidelines for the Management of Hypertension, WHO determined in 2000 that in future the evidence base for all of its guidelines will be explicitly documented according to a defined methodology. In 2002 the World Health Report on Reducing Risks and Promoting Health Life documented the burden of disease (4.5%) related to blood pressure, and subsequently decided to establish comprehensive guidelines to help bring about a paradigm shift to a holistic multiple risk factor approach and facilitate policy development for implementation of population based strategies. ISH will be part of this process. The 2003 WHO/ISH Statement on Management of Hypertension focuses on key areas where new information has become available since the 1999 Guidelines, including establishment of thresholds and goals, treatment strategies and cost-effectiveness. It will be published in the Journal of Hypertension during 2003.

Global Health↗