The peridopril protection against recurrent stroke study (PROGRESS) investigated the efficacy of blood-pressure reduction in hyper- and normotensive patients with a history of stroke or TIA (1).
Recurrent stroke was reduced in patients randomised to anti-hypertensive treatment.
The study authors suggest that perindopril and indapamide therapy should be considered routinely for patients with a history of stroke or TIA - however the routine use of perindopril and indapamide following a stroke been questioned by some (2).
Summary points (2):
- the PROGRESS trial reports that a "perindopril-based blood-pressure-lowering regimen" provided significant protection against recurrent stroke
- however only the subgroup receiving both perindopril and indapamide had reduced stroke recurrence
- there was significant difference in blood pressure reduction achieved with the combination of indapamide and perindopril versus perindopril alone
- blood pressure differences between the two arms (5/3 mm Hg for perindopril alone v 12/5 mm Hg for the combined therapy) - this may have had a significant effect on risk of stroke rather than an effect of the ACE inhibitor independent of blood pressure reduction
- the study design did not include a subgroup randomised to indapamide alone (previously shown to reduce stroke recurrence) - which thus did not allow assessment of the effect of indapamide alone on reduction of stroke risk
- some reviews of the PROGRESS trial have advocated using perindopril alone for prevention of stroke recurrence - however this does not follow from the findings
- it is important that "..results from major drug trials must be clearly presented to avoid misinterpretation by busy clinicians." (1)
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