doi: 10.1161/01.STR.0000054261.97525.4B
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(Stroke. 2003;34:354.)
© 2003 American Heart Association, Inc.
Advances in Stroke 2002 |
Angiotensin-Converting Enzyme Inhibitors for Stroke Prevention
Is There HOPE for PROGRESS After LIFE?
From the Department of Neurology, Royal Perth Hospital, and the Department of Medicine, University of Western Australia, Perth, Australia.
Correspondence to Graeme J. Hankey, Department of Neurology, Royal Perth Hospital, Wellington St, Perth, Western Australia 6001. E-mail gjhankey@cyllene.uwa.edu.au
Key Words: angiotensin II • angiotensin converting enzyme inhibitors • risk factors • stroke prevention
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
In the 1990s, it was established that increasing blood pressure (BP) is a causal risk factor for stroke and that lowering BP by any major class of antihypertensive medication reduces the risk of first-ever stroke.1 In 2000 and 2001, it was established from the Heart Outcomes Prevention Evaluation (HOPE) trial and particularly the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial that lowering BP in the long term, months to years after stroke, by means of angiotensin-converting enzyme (ACE) inhibitors (perindopril or ramipril) and diuretics (indapamide) reduces the risk of recurrent stroke (and cognitive impairment).2–4 The relative risk (RR) reduction was similar, irrespective of the patient’s baseline BP, age, sex, race, pathological subtype of stroke, and time since stroke onset.2–4 The absolute risk reduction was greater among patients at greater baseline risk and with more intensive reductions in BP.4
In 2001 and 2002, evidence emerged from 3 clinical trials to support the hypothesis, raised 30 years ago,5 that angiotensin II might exert detrimental effects beyond the mechanical damage of high BP and be a risk factor for ischemic stroke independent of its effect on BP.
Evidence for Angiotensin II as a Risk Factor for Stroke, Independent of BP
The first trial was the HOPE study, in which a 32% (95% CI, 16 to 44) reduction in RR of stroke and 20% (95% CI, 10 to 30) reduction in RR of myocardial infarction (MI) among patients allocated ramipril, compared with placebo, was associated with a reduction in daytime office BP of only 3.3 mm Hg systolic and 1.4 mm Hg diastolic.2,3,6 Because previous epidemiological
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