The risk of
stroke is strongly and persistently related to the usual level of both systolic blood pressure (SBP) and diastolic blood pressure (DBP). This relation holds for primary and secondary
stroke, both ischemic and hemorrhagic. The
Perindopril Protection Against Recurrent
Stroke Study (PROGRESS) has now provided definitive evidence that lowering the blood pressure of patients with preexisting
cerebrovascular disease (prior
stroke or
transient ischemic attack [TIA]) also reduces the incidence of secondary
stroke. PROGRESS showed that a flexible blood pressure-lowering regimen involving an
angiotensin-converting enzyme inhibitor (
perindopril) and a
diuretic (
indapamide) reduces the incidence of
stroke, major coronary events, and major vascular events by 28%, 26%, and 26%, respectively. These benefits were associated with an average reduction of 9.0 mm Hg (SBP) and 4.0 mm Hg (DBP). The 28% reduction in
stroke incidence translated into a 24% reduction in
ischemic stroke and a 50% reduction in
hemorrhagic stroke. Combination
therapy with
perindopril and
indapamide decreased blood pressure more effectively than did
perindopril monotherapy (mean reduction of 12.3 mm Hg [SBP] and 5.0 mm Hg [DBP] vs 4.9 mm Hg [SBP] and 2.8 mm Hg [DBP], respectively) and was equally effective in reducing
stroke risk in patients with and without
hypertension. In conclusion, blood pressure-lowering
therapy is now established as the most important measure for primary and secondary
stroke prevention. Results of PROGRESS suggest that
antihypertensive treatment with a combination of
perindopril plus
indapamide should now be routinely considered for all patients with previous
stroke or TIA.