Ninomiya T et al. (2008) Lower blood pressure and risk of recurrent stroke in patients with chronic kidney disease: PROGRESS trial. Kidney Int 73: 963–970

Although lowering of blood pressure is generally associated with a reduced risk of stroke, observational studies have suggested that patients with chronic kidney disease (CKD) who have systolic blood pressure (SBP) <120 mmHg might have an increased risk of stroke. However, an analysis of data from PROGRESS, a trial that investigated the effect on stroke prevention of treatment with the angiotensin-converting-enzyme inhibitor perindopril in patients with prior stroke, has found a continuous direct relationship between lower SBP and reduced risk of stroke in CKD.

Ninomiya et al. analyzed the effect of perindopril versus placebo in 6,071 patients with previous cerebrovascular disease, of whom 1,695 had stage 3 CKD and 62 had stage 4 CKD. Perindopril reduced the risk of recurrent stroke by ∼30% compared with placebo, both in patients with CKD and those without. Stratification of patients by baseline SBP showed that the effect of perindopril on stroke risk was similar for patients with SBP values of <140 mmHg, 140–159 mmHg, and ≥160 mmHg in both the CKD and the non-CKD groups. Following adjustment for age, sex, and other risk factors, a log-linear relationship was found between follow-up SBP level and stroke risk both for patients with and those without CKD.

The authors conclude that low blood pressure targets, including that of <120/80 mmHg, do not seem to be associated with increased risk of recurrent stroke in patients with CKD and are actually more likely to protect against recurrent stroke in such patients.