Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Mar 18;332(7542):635-7.
doi: 10.1136/bmj.38758.600116.AE. Epub 2006 Feb 24.

Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study

Jonathan Mant  1 , Richard J McManus, Rachel Hare
Affiliations

Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study

Jonathan Mant et al. BMJ. .

Abstract

Objective: To compare the characteristics of patients with cerebrovascular disease in primary care with those of the participants in the PROGRESS trial, on which national guidelines for blood pressure lowering are based.

Design: Population based cross sectional survey of patients with confirmed stroke or transient ischaemic attack.

Setting: Seven general practices in south Birmingham, England.

Participants: All patients with a validated history of stroke (n = 413) or transient ischaemic attack (n = 107).

Patient characteristics: age, sex, time since last cerebrovascular event, blood pressure, and whether receiving antihypertensive treatment.

Results: Patients were 12 years older than the participants in PROGRESS and twice as likely to be women. The median time that had elapsed since their cerebrovascular event was two and a half years, compared with eight months in PROGRESS. The systolic blood pressure of 315 (61%) patients was over 140 mm Hg, and for 399 (77%) it was over 130 mm Hg. One hundred and forty seven (28%) patients were receiving a thiazide diuretic, and 136 (26%) were receiving an angiotensin converting enzyme inhibitor.

Conclusions: Important differences exist between the PROGRESS trial participants and a typical primary care stroke population, which undermine the applicability of the trial's findings. Research in appropriate populations is urgently needed before the international guidelines are implemented in primary care.

PubMed Disclaimer

Comment in

References

    1. Intercollegiate Stroke Working Party. National clinical guidelines for stroke. 2nd ed. London: Royal College of Physicians of London, 2004.
    1. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004;18: 139-85. - PubMed
    1. Chalmers J, Todd A, Chapman N, Beilin L, Davis S, Donnan G, et al. International Society of Hypertension (ISH): statement on blood pressure lowering and stroke prevention. J Hypertens 2003;21: 651-63. - PubMed
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42: 1206-52. - PubMed
    1. PROGRESS Collaborative Group. Randomised trial of a perindoprilbased blood pressure lowering regimen among 6,105 individuals with a previous stroke or transient ischaemic attack. Lancet 2001;358: 1033-41. - PubMed

Publication types