Evidence-Based Use of Medical Therapy in Secondary Stroke Prevention

Abdullah Nassief, MBBS, M.D. -- Department of Neurology
Washington University School of Medicine -- Presented August 22, 2006

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Remarks:

The selection criteria are few and simple:


• History of non-disabling cerebrovascular disease within past five years.


•A patient who suffered a stroke that has occurred within the last two months could not be included because PROGRESS focuses on long-term management of stroke, not on the acute phase after a stroke. (During the first weeks after a stroke, BP is often elevated but then falls spontaneously.  In addition, the normal mechanisms of cerebral circulatory autoregulation are impaired and hypotensive medications have to be applied with care, on an individual basis.)


•The level of blood pressure is not an eligibility criterion.  The patient was considered for the trial independently of whether they were normotensive or hypertensive.


• The study drugs are added to any therapy a patient had before inclusion, even if the patient is already on a BP lowering drug (except if the patient already has an ACE inhibitor).
 
•If a patient already is treated with an ACE inhibitor, they are not eligible for PROGRESS.


•If a patient receives a diuretic, they are still eligible for the trial.  They will then receive only perindopril (or its matching placebo), and not indapamide (or its matching placebo).


References

Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack.
PROGRESS Collaborative Group
Lancet. 2001 Sep 29;358(9287):1033-41.
Stroke Trials Directory: PROGRESS

 

Internet Stroke Center at Washington University:
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