A long-acting ACE inhibitor used to reduce blood pressure significantly decreased the risk for cardiovascular disease, including stroke, in normal weight, overweight and obese patients, according to research reported in Hypertension: Journal of the American Heart Association.

In the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), the rate of cardiovascular disease declined by more than 25 percent in normal weight, overweight and obese patient groups. The greatest benefit occurred in the heaviest patients, who started the study with higher blood pressure than their leaner counterparts, researchers said.

The treatment prevented one major cardiovascular event - defined as stroke, heart attack or cardiovascular death - for every 13 obese patients treated, compared with one such event prevented for every 28 patients in the group that weighed the least.

"The absolute risk reduction was almost twice as great in the obese group," the investigators wrote in the journal. "These findings have important implications in the management of hypertension in the obese."

Although obesity is a recognized risk factor for stroke and other cardiovascular diseases, little is known about the effects of blood pressure-reducing medication on stroke incidence among obese patients.

To clarify these effects, investigators randomly assigned normal weight, overweight and obese patients either to receive the blood pressure-lowering drug perindopril or a placebo.

The five-year, international study included 6,105 people from 10 countries who had suffered a stroke within the previous five years.
In the United States, an estimated 81 million people suffer from cardiovascular disease, according to the American Heart Association.

Stroke killed an estimated 133,900 people in 2006, making it the third-leading cause of death after diseases of the heart and cancer. For those who survive, stroke is a leading primary cause of long-term disability.

Stroke occurs when blood flow and oxygen to the brain is interrupted or blocked, either by a broken blood vessel or an obstruction, such as a blood clot. A stroke is a medical emergency that requires immediate treatment.

To help reduce the risk of stroke and other cardiovascular diseases, the American Heart Association recommends controlling weight and blood pressure, exercising, eating a healthy diet, and avoiding smoking.

The lead author of the study is Sébastien Czernichow, M.D., Ph.D., associate professor of nutrition at Avicenne Hospital, University of Paris 13.

Co-authors are Toshiharu Ninomiya, M.D., Ph.D.; Rachel Huxley, D.Phil.; André-Pascal Kengne, M.D.; G. David Batty, Ph.D., M.Sc.; Diederick E. Grobbee, M.D., Ph.D.; Mark Woodward, Ph.D.; Bruce Neal, M.D., Ph.D.; and John Chalmers, M.D.

Funding sources: Servier, the Health Research Council of New Zealand, and the National Health and Medical Research Council of Australia.

Author disclosures are on the manuscript.

Notes

-- High blood pressure information for patients is at americanheart/hbp.

-- High blood pressure (HBP) is defined as:

- Systolic (top number) blood pressure 140 mm Hg and higher or diastolic (bottom number) blood pressure 90 mm Hg and higher, or
- taking antihypertensive medicine, or
- having been told at least twice by a physician or other health professional that one has HBP.

-- One in three U.S. adults has HBP.

-- An estimated 74,500,000 adults age 20 and older have HBP.

-- Blood pressure is a powerful determinant of risk for both ischemic stroke and intercranial hemorrhage. People with blood pressure lower than 120/80 mm Hg have about half the lifetime risk of stroke compared to those with HBP.

-- About 69 percent of people who have a first heart attack, 77 percent of those who have a first stroke and 74 percent of those who have congestive heart failure have blood pressure higher than 140/90 mm Hg.

Source
American Heart Association