title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: St Mary's Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Chapman
authors.forename: R
authors.initials: R
authors.lastname: Huxley
authors.forename: C
authors.initials: C
authors.lastname: Anderson
authors.forename: M G
authors.initials: MG
authors.lastname: Bousser
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
authors.forename: S
authors.initials: S
authors.lastname: Colman
authors.forename: S
authors.initials: S
authors.lastname: Davis
authors.forename: G
authors.initials: G
authors.lastname: Donnan
authors.forename: S
authors.initials: S
authors.lastname: MacMahon
authors.forename: B
authors.initials: B
authors.lastname: Neal
authors.forename: C
authors.initials: C
authors.lastname: Warlow
authors.forename: M
authors.initials: M
authors.lastname: Woodward
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002545:Brain Ischemia / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000188:drug therapy*; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007190:Indapamide / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use*; D012306:Risk; D055502:Secondary Prevention; D020521:Stroke / Q000145:classification / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D007190:Indapamide; D020913:Perindopril