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Lowering of Blood Pressure Reduces Risk of Recurrent Stroke (pp 1026, 1033)
September 26, 2001Combination drug treatment to lower blood pressure could substantially reduce the risk of recurrent stroke, conclude authors of a fast-track study published in this week's issue of The Lancet.
Each year stroke effects 20 million people worldwide, kills 5 million people, and a third of 15 million non-fatal strokes result in severe disability. For people with a history of stroke and other cerebrovascular disease, raised blood pressure is a known risk factor; however, no blood-pressure lowering treatment has been proven to reduce recurrent stroke risk among these patients. The perindopril protection against recurrent stroke study (PROGRESS), led by Stephen MacMahon from the Institute for International Health, University of Sydney, Australia, assessed the effects of blood-pressure-lowering treatment in hypertensive and non-hypertensive patients with a history of stroke or transient ischaemic attack.
6105 patients from 172 centres in Asia, Australasia, and Europe took part in the study. They were randomly assigned either a flexible regimen of the angiotensin-converting-enzyme inhibitor perindopril, and (as directed by physicians) the diuretic indapamide (active treatment), or placebo. The primary outcome was total fatal or non-fatal stroke.
Overall, blood pressure was lowered (by 9/4 mm Hg) and the incidence of stroke was lower in patients given perindopril/ indapamide than patients given placebo (10% compared with 14%) at four-year follow-up. There were similar reductions in the risk of stroke in patients given active treatment irrespective of whether they had high or normal blood pressure. Patients given combination therapy with perindopril and indapamide had their blood pressure reduced by 12/5 mm Hg and stroke risk reduced by 43%. Single-drug therapy reduced blood pressure by 5/3 mm Hg and produced no discernable reductions in the risk of stroke or of major vascular events. The investigators conclude that treatment with perindopril and indapamide should now be considered routinely for patients with a history of stroke or transient ischaemic attack, irrespective of their blood pressure.
In an accompanying Commentary (p 1023), Jan Staessen from the University of Leuven, Belgium, concludes: "Because of the sheer number of patients who, on the basis of the results of PROGRESS, are becoming eligible for blood-pressure-lowering therapy, further research should be done to clarify whether drugs in classes more expensive than diuretics, in particular angiotensin-converting enzyme inhibitors, qualify as initial blood-pressure-lowering agents for the secondary prevention of stroke."
Lancet
Overall, blood pressure was lowered (by 9/4 mm Hg) and the incidence of stroke was lower in patients given perindopril/ indapamide than patients given placebo (10% compared with 14%) at four-year follow-up. There were similar reductions in the risk of stroke in patients given active treatment irrespective of whether they had high or normal blood pressure. Patients given combination therapy with perindopril and indapamide had their blood pressure reduced by 12/5 mm Hg and stroke risk reduced by 43%. Single-drug therapy reduced blood pressure by 5/3 mm Hg and produced no discernable reductions in the risk of stroke or of major vascular events. The investigators conclude that treatment with perindopril and indapamide should now be considered routinely for patients with a history of stroke or transient ischaemic attack, irrespective of their blood pressure.
In an accompanying Commentary (p 1023), Jan Staessen from the University of Leuven, Belgium, concludes: "Because of the sheer number of patients who, on the basis of the results of PROGRESS, are becoming eligible for blood-pressure-lowering therapy, further research should be done to clarify whether drugs in classes more expensive than diuretics, in particular angiotensin-converting enzyme inhibitors, qualify as initial blood-pressure-lowering agents for the secondary prevention of stroke."
Lancet
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Fat around the middle increases the risk of dementia
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New discovery about the formation of new brain cells
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Multiple health concerns surface as winter, vitamin D deficiences arrive
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Surgery not linked to memory problems in older patients
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Pushing the brain to find new pathways
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Night Beat, Overtime and a Disrupted Sleep Pattern Can Harm Officers' Health
A police officer who works the night shift, typically from 8 p.m. to 4 a.m., already is at a disadvantage when it comes to getting a good "night's" sleep.
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
The benefits of exercise
Physical exercise is one of the most effective methods of preventing disease. The current issue of Deutsches Arzteblatt International is devoted to this important topic.
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