Volume 2, Number 3, September 2001

Blood pressure and stroke; the PROGRESS trial
Feng J He, Graham A MacGregor

It is well established that increasing blood pressure (BP) is the most important contributory factor to primary stroke. Epidemiological studies show a continuous and graded relationship between BP and the risk of primary stroke, and treatment trials in hypertension demonstrate a major reduction in the risk of primary stroke. Accumulating evidence suggests that there is a similar relationship between BP and secondary (or recurrent) stroke as with primary stroke. Analysis of the data from the UK-TIA (transient ischaemic attack) aspirin trial showed a direct and continuous relationship between the usual levels of BP and subsequent risk of recurrent stroke. However, there has, until now, been controversy over whether the long-term lowering of BP following a stroke carries similar benefits as those in primary stroke. It was therefore with great anticipation that the results of the PROGRESS study (Perindopril Protection Against Recurrent Stroke Study), were presented at the European Society of Hypertension Meeting in Milan in June 2001. The results demonstrate that lowering BP with a combination of an angiotensin-converting enzyme inhibitor (ACE-I) (perindopril) and diuretic (indapamide) causes a major reduction in recurrent stroke, and also other cardiovascular complications, and very importantly shows an equal benefit in both hypertensive and normotensive subjects with a history of stroke or TIA. Whilst there will be questions as to exactly what therapy should be used and how far BP should be lowered, all patients who have had a stroke or TIA should now be considered for BP-lowering therapy, irrespective of their starting level of BP. The PROGRESS study demonstrates that the combination of a diuretic with an ACE-I causes major reductions in subsequent cardiovascular complications in these individuals.

JRAAS 2001;2:153-155.

View full PDF article (open in new window)
Email this article

Right click on this DOI link and copy link to cite this article (What is a DOI link?)