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PROGRESS (perindopril protection against recurrent stroke study)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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)

Reference:


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