Poststroke patients: implications for the cardiologist

PROGRESS (Perindopril pROtection aGainst REcurrent Stroke Study) was the first trial specifically designed to determine the effects of blood pressure lowering on stroke and cardiac events among patients with a history of cerebrovascular disease, regardless of age, sex, ethnicity, concomitant therapy or blood pressure. A total of 6105 individuals with previous stroke or transient ischaemic attack were randomly assigned to receive active treatment with the angiotensin-converting enzyme inhibitor perindopril (4 mg/day), with the addition of the diuretic indapamide at the discretion of treating physicians. After 4 years of follow-up, perindopril-based therapy not only reduced the risk for stroke by 28% (⁠ \(P\ {<}\ 0.0001\) ⁠) but also reduced the risk for total coronary events by 21% (⁠ \(P\ =\ 0.008\) ⁠), including a 38% reduction in non-fatal myocardial infarction, and the risk for congestive heart failure by 26% (⁠ \(P\ =\ 0.02\) ⁠). Both stroke and ischaemic heart disease make huge contributions to the overall global burden of disease, and so these positive results should have major implications for cardiovogists. In addition, heart failure is more common in patients with vascular disease, and represents a further and increasing public health problem in industrialized countries with ageing populations. Finally, the management of patients with previous stroke and normal blood pressure remained an unmet medical need in clinical medicine. PROGRESS has demonstrated that a perindopril-based regimen is of clinical importance for preventing stroke and cardiac events in both hypertensive and non-hypertensive patients with stroke or transient ischaemic attack.