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Trials on blood pressure-lowering and secondary stroke prevention
1Institute for International Health, University of Sydney, Newton, NSW, Australia. chalmers@jih.usyd.edu.au
Insights
Lowering blood pressure with perindopril and indapamide significantly reduces stroke risk in patients with prior stroke or TIA. This combination therapy is a crucial measure for both primary and secondary stroke prevention.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) are strongly linked to stroke risk.
- This association applies to all stroke types, including ischemic and hemorrhagic.
- Previous studies indicated a need for definitive evidence on blood pressure reduction for secondary stroke prevention.
Purpose of the Study:
- To evaluate the efficacy of a flexible blood pressure-lowering regimen in preventing recurrent stroke.
- To assess the impact of combination therapy (perindopril and indapamide) on major vascular events.
- To determine the effectiveness of this regimen in patients with pre-existing cerebrovascular disease.
Main Methods:
- The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) involved patients with prior stroke or transient ischemic attack (TIA).
- A flexible regimen using an angiotensin-converting enzyme inhibitor (perindopril) and a diuretic (indapamide) was administered.
- Blood pressure changes and event rates (stroke, coronary events, vascular events) were monitored.
Main Results:
- Combination therapy reduced stroke incidence by 28%, major coronary events by 26%, and major vascular events by 26%.
- Average blood pressure reduction was 9.0 mm Hg for SBP and 4.0 mm Hg for DBP.
- Stroke reduction included a 24% decrease in ischemic stroke and a 50% decrease in hemorrhagic stroke.
Conclusions:
- Blood pressure-lowering therapy is paramount for primary and secondary stroke prevention.
- Combination therapy with perindopril and indapamide demonstrated superior blood pressure reduction compared to monotherapy.
- Routine consideration of perindopril plus indapamide is recommended for patients with a history of stroke or TIA.
Abstract:
The risk of stroke is strongly and persistently related to the usual level of both systolic blood pressure (SBP) and diastolic blood pressure (DBP). This relation holds for primary and secondary stroke, both ischemic and hemorrhagic. The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) has now provided definitive evidence that lowering the blood pressure of patients with preexisting cerebrovascular disease (prior stroke or transient ischemic attack [TIA]) also reduces the incidence of secondary stroke. PROGRESS showed that a flexible blood pressure-lowering regimen involving an angiotensin-converting enzyme inhibitor (perindopril) and a diuretic (indapamide) reduces the incidence of stroke, major coronary events, and major vascular events by 28%, 26%, and 26%, respectively. These benefits were associated with an average reduction of 9.0 mm Hg (SBP) and 4.0 mm Hg (DBP). The 28% reduction in stroke incidence translated into a 24% reduction in ischemic stroke and a 50% reduction in hemorrhagic stroke. Combination therapy with perindopril and indapamide decreased blood pressure more effectively than did perindopril monotherapy (mean reduction of 12.3 mm Hg [SBP] and 5.0 mm Hg [DBP] vs 4.9 mm Hg [SBP] and 2.8 mm Hg [DBP], respectively) and was equally effective in reducing stroke risk in patients with and without hypertension. In conclusion, blood pressure-lowering therapy is now established as the most important measure for primary and secondary stroke prevention. Results of PROGRESS suggest that antihypertensive treatment with a combination of perindopril plus indapamide should now be routinely considered for all patients with previous stroke or TIA.