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(Stroke. 2003;34:2333.)
© 2003 American Heart Association, Inc.

Original Contributions

Effects of a Perindopril-Based Blood Pressure–Lowering Regimen on Disability and Dependency in 6105 Patients With Cerebrovascular Disease

A Randomized Controlled Trial

A list of the members of the PROGRESS Collaborative Group and their affiliations appears in the Appendix.

Correspondence to Dr John Chalmers, Institute for International Health, University of Sydney, PO Box 576, Newtown, Sydney, New South Wales 2042, Australia. E-mail chalmers{at}iih.usyd.edu.au

Background and Purpose— We sought to quantify the effects of blood pressure lowering on long-term disability and dependency among patients with cerebrovascular disease.

Methods— We performed a randomized, double-blind, placebo-controlled trial. A total of 6105 participants with a history of stroke or transient ischemic attack in the past 5 years were recruited from 172 hospital outpatient clinics in 10 countries. Subjects were randomly assigned to the following groups: active treatment (angiotensin-converting enzyme inhibitor perindopril [4 mg/d] for all patients, with the diuretic indapamide added at the discretion of treating physicians) or matching placebo(s). Measurements were disability (defined as a Barthel Index score 99/100) and dependency (a positive response to the following question: "In the last 2 weeks has the patient required regular help with everyday activities?").

Results— The median duration of follow-up was 4 years. At the last available assessment, 19% of the active treatment group and 22% of the placebo group were disabled (adjusted odds ratio, 0.76; 95% CI, 0.65 to 0.89; P<0.001). Twelve percent of the active treatment group and 14% of the placebo group were dependent (adjusted odds ratio, 0.84; 95% CI, 0.71 to 0.99; P=0.04). The effects of treatment appeared to be mediated primarily through the prevention of disability and dependency associated with recurrent stroke. Four-year treatment with the study drug regimen would be expected to result in the avoidance of 1 case of long-term disability for every 30 (95% CI, 19 to 79) patients.

Conclusions— Among individuals with cerebrovascular disease, a perindopril-based blood pressure–lowering regimen not only reduced the risk of stroke and major vascular events but also substantially reduced the risks of associated long-term disability and dependency.

Key Words: antihypertensive therapy • indapamide • perindopril • stroke, hemorrhagic • stroke, ischemic

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