Recent epidemiological studies have shown a J-shaped association between the risk of
stroke and systolic blood pressure (SBP) levels in people with
chronic kidney disease (CKD). The
Perindopril Protection Against Recurrent
Stroke Study (PROGRESS) was a randomized, placebo-controlled trial demonstrating that
perindopril-based blood pressure (BP) lowering reduced the risk of
stroke in 6105 participants with prior
cerebrovascular disease. We estimated the effects of
therapy on the risk of recurrent
stroke in 1757 of these participants with stage 3 or greater CKD according to baseline BP and the relationship between achieved follow-up BP and the risk of
stroke. Active
therapy produced comparable and significant reductions in the risk of
stroke across all baseline SBP levels. The age- and gender-adjusted incidence of
stroke increased significantly in a log-linear relationship for achieved SBP levels and
strokes per 1000 person-years. This association persisted after adjusting for potential confounding factors. We found that
perindopril-based BP lowering effectively prevented recurrent
stroke in people with CKD, across a wide range of BP levels, without evidence of an increased risk of
stroke in people with low BP levels.