Copyright © 2003 by the European Society of Cardiology.
Effects of a perindopril-based blood pressure lowering regimen on cardiac outcomes among patients with cerebrovascular disease
PROGRESS Collaborative Group1,*PROGRESS Collaborative Group c/o Institute for International Health, University of Sydney,P.O. Box 576, Newtown, Sydney, NSW 2042, Australia
Received October 15, 2002;
accepted October 16, 2002
* Corresponding author. Professor John Chalmers. Tel.: +61- 2-9351-0063; fax: +61-2-9351-0064
E-mail address: progress{at}iih.usyd.edu.au
Aim To determine the effects of a perindopril-based blood pressure lowering regimen on major cardiac events among hypertensive and non-hypertensive patients with a history of cerebrovascular disease.
Methods and results A total of 6105 individuals with a history of stroke or transient ischaemic attack were randomly assigned active treatment 
or placebo 
. Active treatment comprised the angiotensin-converting-enzyme inhibitor perindopril (4mg daily), with the addition of the diuretic indapamide at the discretion of treating physicians. Over a mean of 3.9 years of follow-up, active treatment reduced blood pressure by 9/4mmHg compared with placebo and reduced the primary outcome, stroke, by 28%. Major coronary events occurred in 269 participants (active 3.8%, placebo 5.0%) and heart failure was diagnosed in 264 participants (active 3.7%, placebo 4.9%). Active treatment reduced the risk of major coronary events by 26% (95% CI: 6–42%; 
) and the risk of congestive heart failure by 26% (5–42%; ). For each of these outcomes, there was no clear evidence of differences between the treatment effects in participants classified as hypertensive or non-hypertensive, and those with or without a history of coronary heart disease.
Conclusions Among individuals with cerebrovascular disease, blood pressure lowering with a regimen involving perindopril and indapamide not only reduced the risk of stroke, but also substantially reduced the risks of cardiac outcomes.
Key Words: ACE inhibitor • Blood pressure • Congestive heart failure • Coronary heart disease • Diuretic • Indapamide • Perindopril • Randomised trial
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