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Isolated diastolic hypertension in patients with cerebrovascular disease should be treated

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Treatment of isolated diastolic hypertension in patients with cerebrovascular disease protects against major vascular events, according to results from the PROGRESS trial.

“For patients with previous stroke or TIA, isolated diastolic hypertension should be treated routinely and in the same way as isolated systolic or systolic-diastolic hypertension,” Dr. John Chalmers from University of Sydney, Sydney, Australia told Reuters Health in an email.

Dr. Chalmers and colleagues in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) investigated whether blood pressure lowering provides the same protection among patients with isolated diastolic hypertension as it does among patients with other forms of hypertension.

The analysis included 4283 patients with cerebrovascular disease and hypertension who were randomly assigned to active treatment (perindopril with or without indapamide) or placebo. The findings appear in the June 23rd online Stroke.

Compared with placebo, active treatment reduced the risk of major vascular events by 27% in patients with isolated systolic hypertension, by 28% in those with isolated diastolic hypertension, and by 32% in patients with systolic-diastolic hypertension.

The magnitude of protection against major vascular events did not differ significantly among the different types of hypertension, and results were comparable for subgroups defined by age, sex, geographic region, and baseline use of antihypertensive medications.

Blood pressure and risk reductions were consistently greater with combination therapy than with perindopril alone.

“Our evidence is restricted to patients with stroke or TIA and in this group, most definitely, all patients with isolated diastolic hypertension should receive active blood pressure lowering treatment,” Dr. Chalmers said.

“On the other hand, there is no randomized evidence of blood pressure lowering treatment for patients with isolated diastolic hypertension who have not had previous stroke or TIA,” Dr. Chalmers explained. “However, recent large-scale observational studies have demonstrated that isolated diastolic hypertension is associated with increased risks of cardiovascular disease in general populations. Therefore, it seems to be reasonable to extrapolate the current evidence to patients with isolated diastolic hypertension who have not had stroke or TIA.”

Stroke 23 June 2011.