Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack
- PMID: 11589932
- DOI: 10.1016/S0140-6736(01)06178-5
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack
Erratum in
- Lancet 2001 Nov 3;358(9292):1556
- Lancet 2002 Jun 15;359(9323):2120
Abstract
Background: Blood pressure is a determinant of the risk of stroke among both hypertensive and non-hypertensive individuals with cerebrovascular disease. However, there is uncertainty about the efficacy and safety of blood-pressure-lowering treatments for many such patients. The perindopril protection against recurrent stroke study (PROGRESS) was designed to determine the effects of a blood-pressure-lowering regimen in hypertensive and non-hypertensive patients with a history of stroke or transient ischaemic attack.
Methods: 6105 individuals from 172 centres in Asia, Australasia, and Europe were randomly assigned active treatment (n=3051) or placebo (n=3054). Active treatment comprised a flexible regimen based on the angiotensin- converting-enzyme inhibitor perindopril (4 mg daily), with the addition of the diuretic indapamide at the discretion of treating physicians. The primary outcome was total stroke (fatal or non-fatal). Analysis was by intention to treat.
Findings: Over 4 years of follow up, active treatment reduced blood pressure by 9/4 mm Hg. 307 (10%) individuals assigned active treatment suffered a stroke, compared with 420 (14%) assigned placebo (relative risk reduction 28% [95% CI 17-38], p<0.0001). Active treatment also reduced the risk of total major vascular events (26% [16-34]). There were similar reductions in the risk of stroke in hypertensive and non-hypertensive subgroups (all p<0.01). Combination therapy with perindopril plus indapamide reduced blood pressure by 12/5 mm Hg and stroke risk by 43% (30-54). Single-drug therapy reduced blood pressure by 5/3 mm Hg and produced no discernable reduction in the risk of stroke.
Interpretation: This blood-pressure-lowering regimen reduced the risk of stroke among both hypertensive and non-hypertensive individuals with a history of stroke or transient ischaemic attack. Combination therapy with perindopril and indapamide produced larger blood pressure reductions and larger risk reductions than did single drug therapy with perindopril alone. Treatment with these two agents should now be considered routinely for patients with a history of stroke or transient ischaemic attack, irrespective of their blood pressure.
Comment in
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Blood-pressure lowering for the secondary prevention of stroke.Lancet. 2001 Sep 29;358(9287):1026-7. doi: 10.1016/S0140-6736(01)06226-2. Lancet. 2001. PMID: 11589927 No abstract available.
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The lowering of blood pressure after stroke.Lancet. 2001 Dec 8;358(9297):1993; author reply 1994-5. doi: 10.1016/S0140-6736(01)06979-3. Lancet. 2001. PMID: 11747943 No abstract available.
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The lowering of blood pressure after stroke.Lancet. 2001 Dec 8;358(9297):1993; author reply 1994-5. doi: 10.1016/S0140-6736(01)06978-1. Lancet. 2001. PMID: 11747944 No abstract available.
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The lowering of blood pressure after stroke.Lancet. 2001 Dec 8;358(9297):1993-4; author reply 1994-5. doi: 10.1016/S0140-6736(01)06980-X. Lancet. 2001. PMID: 11747945 No abstract available.
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The lowering of blood pressure after stroke.Lancet. 2001 Dec 8;358(9297):1994; author reply 1994-5. doi: 10.1016/S0140-6736(01)06981-1. Lancet. 2001. PMID: 11747946 No abstract available.
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Combined therapy with indapamide and perindopril but not perindopril alone reduced the risk for recurrent stroke.ACP J Club. 2002 Mar-Apr;136(2):51. ACP J Club. 2002. PMID: 11874276 No abstract available.
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Does lowering blood pressure prevent recurrent stroke?Med J Aust. 2002 Mar 18;176(6):283-4. doi: 10.5694/j.1326-5377.2002.tb04410.x. Med J Aust. 2002. PMID: 11999264 No abstract available.
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Who is fooling us?Lancet. 2002 Jul 6;360(9326):89. doi: 10.1016/S0140-6736(02)09348-0. Lancet. 2002. PMID: 12114069 No abstract available.
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Blood pressure and secondary prevention of strokes. How low should we go? Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack.Can Fam Physician. 2002 Oct;48:1625-9. Can Fam Physician. 2002. PMID: 12474869 Free PMC article. No abstract available.
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Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack.Curr Cardiol Rep. 2003 Mar;5(2):140. Curr Cardiol Rep. 2003. PMID: 12583858 No abstract available.
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