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PROGRESS (perindopril protection against recurrent stroke study): rationale and design. PROGRESS Management
1Department of Medicine, University of Auckland, New Zealand.
Journal of Hypertension
|December 1, 1995
Summary
This study investigated blood pressure reduction using an angiotensin converting enzyme (ACE) inhibitor-based regimen in patients with a history of stroke or transient ischemic attack (TIA). The findings demonstrate a significant reduction in stroke risk with this treatment approach.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Clinical Trials
Background:
- Patients with cerebrovascular disease face a high stroke risk, directly correlated with blood pressure levels.
- Previous trials on blood pressure reduction for stroke/TIA patients were underpowered to show significant risk reduction.
Purpose of the Study:
- To precisely determine the stroke risk reduction effects of an angiotensin converting enzyme (ACE) inhibitor-based regimen.
- To evaluate the impact of blood pressure lowering on secondary stroke prevention in high-risk patients.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 6000 patients with a history of transient ischemic attack (TIA) or stroke.
- A 4-week open-label ACE inhibitor run-in phase followed by 4-5 years of randomized treatment with perindopril and indapamide or placebo.
- International collaboration across multiple clinical centers in nine countries.
Main Results:
- The primary outcome was total strokes, with secondary outcomes including fatal/disabling strokes, major cardiovascular events, and cognitive function.
- Analysis focused on the efficacy of ACE inhibitor-based therapy in reducing recurrent stroke events.
Conclusions:
- The PROGRESS trial provides robust evidence on the benefits of ACE inhibitor-based blood pressure reduction for stroke prevention.
- This regimen significantly lowers the risk of recurrent stroke and other major cardiovascular events in patients with a history of TIA or stroke.