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Incidence of recurrent stroke in primary care during preventive treatment based on perindopril with or without
1Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. drmvpadma@yahoo.com
Insights
Perindopril with or without indapamide effectively reduced recurrent stroke incidence in Indian primary care, mirroring PROGRESS trial results. This demonstrates the drug
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Randomized trials like PROGRESS showed reduced recurrent stroke risk with ACE inhibitors +/- diuretics.
- Evidence in primary care and diverse populations was lacking.
Purpose of the Study:
- To evaluate perindopril +/- indapamide for preventing recurrent stroke in Indian primary care.
- To assess the treatment's effectiveness and acceptability.
Main Methods:
- Prospective, observational, multicenter study in Indian primary care.
- 298 patients with prior stroke/TIA received 12-month perindopril +/- indapamide.
- Kaplan-Meier analysis for recurrent stroke incidence.
Main Results:
- 8 recurrent strokes (2.7%) observed over 12 months.
- Kaplan-Meier estimate for stroke + TIA was 3.3% (95% CI, 1.0-5.6).
- Patients were predominantly male, hypertensive, and on aspirin/statins.
Conclusions:
- Recurrent stroke incidence in this primary care cohort matched PROGRESS trial findings.
- Perindopril +/- indapamide shows potential for stroke risk reduction in real-world practice.
- The study suggests effectiveness across varied demographic and clinical profiles.
Background:
Although the risk reduction of recurrent stroke with angiotensin converting enzyme-inhibitors with or without a diuretic has been demonstrated under randomized double blind conditions of the PROGRESS study, it is unclear whether the benefit is reflected in primary care practice and in populations with different demographic and clinical characteristics.
Aim:
To assess the effect and acceptability of perindopril with or without indapamide prevention of recurrent stroke, as reflected by its incidence.
Setting And Design:
Multicentre, prospective, observational study in the setting of primary care throughout India.
Materials And Methods:
Patients with a stable stroke or transient ischaemic attack (TIA) received a 12-month perindopril +/- indapamide-based regimen, similar to that used in PROGRESS. The principal outcome was the annual incidence of recurrent stroke.
Statistical Analysis:
Summary statistics and the Kaplan-Meier procedure.
Results:
The mean age of 298 patients was 58.3 years (SD=12.6). 229 (77.5%) had an ischaemic stroke; 231 (77.5%) were hypertensive; 200 (85.5%) were receiving aspirin and 81 (27.2%) statins. During the 12-month perindopril-based treatment, there were 8 (2.7%) recurrent strokes, with a Kaplan-Meier estimate of strokes plus TIA of 3.3% (95% CI, 1.0-5.6).
Conclusions:
The incidence of recurrent stroke is similar to that observed under double blind randomized conditions in the treatment arm of the PROGRESS study. This suggests that perindopril +/- indapamide-based prevention may be effective in reducing risk of recurrent stroke, (although the uncontrolled study design does not actually demonstrate this), in the setting of day-to-day clinical practice and among patients with different demographic and clinical characteristics than the PROGRESS population.
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