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PROGRESS (Perindopril Protection Against Recurrent Stroke Study): regional characteristics of the study population at
J Chalmers1, B Neal, S MacMahon
1Royal North Shore Hospital, Sydney, NSW, Australia. jchalmers@med.usyd.edu.au
Insights
This study investigated if an ACE inhibitor regimen reduces stroke risk in patients with prior cerebrovascular disease. The trial found consistent patient characteristics across diverse global regions, aiding future research.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Clinical Trials
Background:
- Patients with a history of cerebrovascular disease are at high risk for recurrent events.
- Blood pressure management is crucial in preventing secondary strokes.
- Angiotensin-converting enzyme (ACE) inhibitors are a key class of antihypertensive medications.
Purpose of the Study:
- To evaluate the efficacy of an ACE inhibitor-based regimen in reducing stroke risk.
- To assess the impact of this treatment on other cardiovascular outcomes, dementia, and disability.
Main Methods:
- The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a double-blind, placebo-controlled, randomized trial.
- 172 centers across 10 countries enrolled 6105 patients.
- Patients received either perindopril (with or without indapamide) or placebo.
Main Results:
- Baseline characteristics showed regional variations in diabetes, stroke types, and prior cardiovascular events.
- Despite regional differences, patient profiles were largely consistent globally.
- Recruitment occurred across Australia, New Zealand, China, France, Belgium, Italy, Japan, Sweden, UK, and Ireland.
Conclusions:
- The study established baseline characteristics of a diverse global patient population with cerebrovascular disease.
- Understanding these characteristics is vital for interpreting treatment effects and designing future clinical trials.
Objective:
To determine the effects of an angiotensin-converting enzyme (ACE) inhibitor-based blood pressure lowering regimen on the risk of stroke among patients with a history of cerebrovascular disease. Secondary aims include investigation of the effects of treatment on other cardiovascular events, dementia, and disability.
Design And Methods:
PROGRESS (Perindopril Protection Against Recurrent Stroke Study) is a double-blind, placebo-controlled, randomized trial being conducted in 172 centres in 10 countries (Australia, Belgium, China, France, Italy, Ireland, Japan, New Zealand, Sweden, and the United Kingdom). Patients were randomly assigned to treatment with the ACE inhibitor perindopril (and the diuretic indapamide for those with no definite indication for or contraindication to treatment with a diuretic) or matching placebo(s). Both hypertensive and normotensive patients were eligible for inclusion. Follow-up is scheduled for completion in 2001.
Results:
Of 6105 patients randomly allocated to study groups on completion of recruitment in November 1997, 1110 were recruited from Australia and New Zealand, 1520 from China, 713 from France and Belgium, 557 from Italy, 815 from Japan, 675 from Sweden, and 715 from the UK and Ireland. Regional differences in the baseline characteristics included a greater rate of diabetes, lacunar infarction, and cerebral haemorrhage in patients from China and Japan, and a more frequent history of myocardial infarction in Australia and New Zealand. Previous treatment with calcium antagonists was very frequent in Japan and China, whereas diuretic treatment was most often documented in the UK and Ireland.
Conclusions:
Analysis of baseline characteristics of patients recruited from seven distinct geographic regions revealed some interesting differences, but more striking was the consistency of characteristics of patients recruited from many different countries across the world.