Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomize

Beitrag in einer Fachzeitschrift


Details zur Publikation

Autor(en): Zanchetti A, Liu L, Mancia G, Parati G, Grassi G, Stramba-Badiale M, Silani V, Bilo G, Corrao G, Zambon A, Scotti L, Zhang X, Wang H, Zhang Y, Zhang X, Guan TR, Berge E, Redon J, Narkiewicz K, Dominiczak A, Nilsson P, Viigimaa M, Laurent S, Agabiti-Rosei E, Wu Z, Zhu D, Luis Rodicio J, Miguel Ruilope L, Martell-Claros N, Pinto F, Schmieder R, Burnier M, Banach M, Cifkova R, Farsang C, Konradi A, Lazareva I, Sirenko Y, Dorobantu M, Postadzhiyan A, Accetto R, Jelakovic B, Lovic D, Manolis AJ, Stylianou P, Erdine S, Dicker D, Wei G, Xu C, Xie H, Coca A, O'Brien J, Ford G
Zeitschrift: Journal of Hypertension
Jahr der Veröffentlichung: 2014
Band: 32
Heftnummer: 9
Seitenbereich: 1888-97
ISSN: 0263-6352


Abstract


The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design.The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125 mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8 mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly.Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be adjudicated by committees blind to randomized allocation. A Data and Safety Monitoring Board has open access to data and can recommend trial interruption for safety.It has been calculated that 925 patients would reach the primary outcome after a mean 4-year follow-up, and this should provide at least 80% power to detect a 25% stroke difference between SBP targets and a 20% difference between LDL-C targets.



FAU-Autoren / FAU-Herausgeber

Schmieder, Roland Prof. Dr.
Professur für Innere Medizin (Nephrologie)


Autor(en) der externen Einrichtung(en)
Asclepeion Hospital
Beijing Anzhen Hospital
Beijing Xuanwu Hospital
Bucharest Emergency University Hospital
Centro Hospitalar de Entre o Douro e Vouga, E.P.E.
Chinese Hypertension League
Federal Almazov North-West Medical Research Centre
Fuwai Cardiovascular Hospital
Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP)
Hospital Clínico San Carlos
Hospital Universitario 12 de Octubre
Istanbul University / İstanbul Üniversitesi
Istituto Scientifico Ospedale San Luca (Istituto Auxologico Italiano)
Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV)
Ljubljana University Medical Centre (Ljubljana UMC) / Univerzitetni klinični center Ljubljana
Lund University / Lunds universitet
M.D. Strazhesko Institute of Cardiology
Medical University Gdansk / Gdański Uniwersytet Medyczny
Medical University of Łódź / Uniwersytet Medyczny w Łodzi
Nicosia General Hospital
Oslo University Hospital / Oslo Universitetssykehus
Oxford University Hospitals NHS Foundation Trust
Peking University (PKU) / 北京大学
Rabin Medical Center / מרכז רפואי רבין‎‎
Respublican Scientific and Practical Center “Cardiology”
St. Imre Teaching Hospital
Tallinn University of Technology
Universidad Complutense de Madrid (UCM)
Università degli Studi di Brescia
Universitat de Barcelona (UB) / University of Barcelona
University Hospital St. Anna
University of Cambridge
University of Glasgow
University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB
University of València / Universitat de València
Univerzita Karlova v Praze / Charles University in Prague
Zagreb University Hospital Centre / Klinički bolnički centar Zagreb (KBC)


Zitierweisen

APA:
Zanchetti, A., Liu, L., Mancia, G., Parati, G., Grassi, G., Stramba-Badiale, M.,... Ford, G. (2014). Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomize. Journal of Hypertension, 32(9), 1888-97. https://dx.doi.org/10.1097/HJH.0000000000000254

MLA:
Zanchetti, Alberto, et al. "Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomize." Journal of Hypertension 32.9 (2014): 1888-97.

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Zuletzt aktualisiert 2018-09-10 um 07:24