Stroke secondary prevention and blood pressure reduction: an observational study of the use of PROGRESS therapy.
The Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) showed the efficacy of blood pressure reduction in secondary stroke prevention. This anti-hypertensive treatment (perindopril 4 mg daily plus indapamide 1.5 mg daily) is now routinely proposed to patients referred to our department for stroke or transient ischaemic attack (TIA). The aim of this study was to evaluate the prescription of PROGRESS therapy during hospitalization and to identify the predictors of therapy discontinuation after discharge. Eligible patients admitted to the Amiens University hospital for acute stroke or TIA from January to April 2003 were included (n = 101). At 1 year, the use of PROGRESS therapy was evaluated by structured phone interviews. In addition, each patient's general practitioner (GP) was also contacted to provide information. PROGRESS therapy was mentioned on the hospital discharge summary significantly less frequently after cardioembolic stroke (OR: 0.15; 95% CI: 0.05-0.5; P = 0.001) and TIA (OR: 0.12; 95% CI: 0.02-0.7; P = 0.02). At 1 year, only 25.7% of patients were treated with optimal PROGRESS therapy (perindopril 4 mg daily plus indapamide 1.5 mg daily). Mention of PROGRESS therapy in the discharge summary was the main predictor of optimal PROGRESS therapy at 1 year (OR: 10.8; 95% CI: 1.3-88.3; P = 0.03). This study shows that mention of PROGRESS therapy in the discharge summary must be improved as it is associated with a higher use of these anti-hypertensive agents 1 year after stroke/TIA.
Bugnicourt
Jean-Marc
JM
Service de Neurologie, and Laboratoire de Neurosciences Fonctionnelles et Pathologies (UMR CNRS 8160), Université d'Amiens, France. bugnicourt.jeanmarc@chu-amiens.fr
Chillon
Jean-Marc
JM
Canaple
Sandrine
S
Lamy
Chantal
C
Godefroy
Olivier
O
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003692:Delayed-Action Preparations; D004232:Diuretics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007190:Indapamide / Q000627:therapeutic use*; D007407:Interviews as Topic; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008297:Male; D020913:Perindopril / Q000627:therapeutic use*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000517:prevention & control*
D000806:Angiotensin-Converting Enzyme Inhibitors; D003692:Delayed-Action Preparations; D004232:Diuretics; D007190:Indapamide; D020913:Perindopril