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(Stroke. 2003;34:2590.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Blood Pressure Lowering for the Secondary Prevention of Stroke: One Size Fits All?

Study Coordinating Centre, Hypertension Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium

An extract of the first 250 words of the full text is provided, because this article has no abstract.

For the secondary prevention of stroke, recent guidelines^1,2 recommend the prescription of blood pressure–lowering drugs to normotensive and hypertensive patients with previous cerebrovascular complications. Two large placebo-controlled trials with double-blind design^3,4 generated most of the supporting evidence. In the Post-Stroke Antihypertensive Treatment Study (PATS),³ 5665 Chinese patients with a history of transient ischemic attack or minor stroke were randomized to indapamide 2.5 mg/d or matching placebo. Follow-up averaged 2 years. Indapamide decreased systolic/diastolic blood pressure by 5/2 mm Hg and stroke recurrence by 29% (P<0.001).³ The Perindopril Protection Against Recurrent Stroke Study (PROGRESS)⁴ included 3753 whites and 2352 Asians. Patients randomized to active treatment received perindopril 4 mg/d either alone or in combination with indapamide 2.5 mg/d. Over 4 years of follow-up, active treatment reduced blood pressure by 9/4 mm Hg and the incidence of recurrent stroke by 28% (P<0.001). In both trials, hypertensive and nonhypertensive patients benefited from treatment. The blood pressure thresholds delineating hypertension were 140/90 mm Hg in PATS and 160/90 mm Hg in PROGRESS. In the nonhypertensive subgroups, the relative risk reductions in stroke recurrence amounted to 49% (n=913) and 27% (n=3189), respectively. Neither PATS³ nor PROGRESS⁴ indicated the level to which blood pressure should be lowered, although goals of <130 mm Hg systolic and 85 mm Hg diastolic, corresponding to current definitions of normotension,² seem reasonable when such targets can be safely reached without side effects.

For various reasons, the PATS³ and PROGRESS⁴ findings cannot be extrapolated to patients with occlusive . . . [Full Text of this Article]