Effects of Blood Pressure Lowering on Major Vascular Events Among Patients With Isolated Diastolic Hypertension The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) Trial

Background and Purpose—Despite clear evidence that blood pressure (BP) lowering is effective for prevention of cardiovascular events among patients with isolated systolic hypertension and systolic–diastolic hypertension, there is ongoing uncertainty about its effects in those with isolated diastolic hypertension. The objective of the present analysis is to determine whether BP lowering provides benefits to patients with isolated diastolic hypertension. Methods—Patients with cerebrovascular disease and hypertension at baseline (n=4283) were randomly assigned to either active treatment (perindopril in all participants plus indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). The primary outcome was total major vascular events. Results—There were 1923 patients with isolated systolic hypertension (systolic BP ≥140 mm Hg and diastolic BP <90 mm Hg), 315 with isolated diastolic hypertension (systolic BP <140 mm Hg and diastolic BP ≥90 mm Hg), and 2045...