on December 11, 2003
Published online before print December 11, 2003, doi: 10.1161/01.STR.0000106480.76217.6F
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Submitted on August 28, 2003
From St Mary’s Hospital, London, UK (N.C.); Institute for International Health, University of Sydney, Sydney, Australia (R.H., J.C., S.C., S.M., B.N., M.W.); Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand (C.A.); Hopital Lariboisiere, Paris, France (M.G.B.); Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia (S.D.); National Stroke Research Institute, Victoria, Australia (G.D.); and Department of Neurology, Western General Hospital, Scotland, UK (C.W.). * To whom correspondence should be addressed. E-mail: progress{at}iih.usyd.edu.au.
Background and Purpose--The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) showed that blood pressure lowering reduced stroke risk in patients with a history of cerebrovascular events. Here, we report the consistency of treatment effects across different stroke subtypes and among major clinical subgroups. Methods--PROGRESS was a randomized, double-blind trial among 6105 people with a prior history of cerebrovascular events. Participants were assigned to active treatment (perindopril for all participants and indapamide for those with neither an indication for nor a contraindication to a diuretic) or matching placebo(s). Results--During a mean of 3.9 years of follow-up, active treatment reduced the absolute rates of ischemic stroke from 10% to 8% (relative risk reduction [RRR], 24%; 95% confidence interval [CI], 10 to 35) and the absolute rates of intracerebral hemorrhage from 2% to 1% (RRR, 50%; 95% CI, 26 to 67). The relative risk of any stroke during follow-up was reduced by 26% (95% CI, 12 to 38) among patients whose baseline cerebrovascular event was an ischemic stroke and by 49% (95% CI, 18 to 68) among those whose baseline event was an intracerebral hemorrhage. There was no evidence that treatment effects were modified by other drug therapies (antiplatelet or other antihypertensive agents), residual neurological signs, atrial fibrillation, or the time since the last cerebrovascular event. Conclusions--Beneficial effects of a perindopril-based treatment regimen were observed for all stroke types and all major clinical subgroups studied. These data suggest that effective blood pressure-lowering therapy should be routinely considered for all patients with a history of cerebrovascular events.
Accepted on September 12, 2003
Effects of a Perindopril-Based Blood Pressure-Lowering Regimen on the Risk of Recurrent Stroke According to Stroke Subtype and Medical History. The PROGRESS Trial
N. Chapman MRCP;
Key words: angiotensin converting enzyme inhibitors • blood pressure • intracerebral hemorrhage • randomized controlled trials • stroke, ischemic
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