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Stroke Prevention Takes Giant Step Forward

WebMD Health News

June 18, 2001 -- Lowering high blood pressure is one of the best ways to prevent stroke and heart disease. Now it turns out that the combination of two blood pressure medications -- perindopril (Aceon) and indapamide -- can prevent stroke even if blood pressure is normal.

These findings from the landmark study PROGRESS (Perindopril Protection Against Recurrent Stroke Study) were announced June 16 at the European Society of Hypertension Congress in Milan, Italy.

"The results of this study are of direct relevance to the care of at least 50 million people worldwide," key PROGRESS investigator Stephen MacMahon, MD, tells WebMD. "If the treatments are implemented widely, several hundred thousand strokes would be avoided each year."

After studying more than 6,000 stroke sufferers worldwide for six years, PROGRESS researchers found that perindopril and indapamide were most effective when used together in decreasing risk of a further stroke and death. "Many would also be spared disability or [stroke-related memory loss] while others would avoid heart attack," says MacMahon, who is Medical Foundation Professor of Cardiovascular Medicine and Epidemiology at the University of Sydney in Australia.

"This combined treatment is the biggest step forward so far in prevention of stroke," PROGRESS study investigator Bruce Neal, PhD, tells WebMD. He is a senior lecturer at the Institute for International Health, University of Sydney in Australia. "In patients who have had a stroke, it cuts the risk of a second stroke by one-quarter to one-half, even if blood pressure is normal."

Says Morris Brown, MD, PhD, a professor of clinical pharmacology at the University of Cambridge in the U.K.: "This is a hugely important finding." He reviewed the study for WebMD.

As more than two-thirds of all strokes occur in people with normal blood pressure, drugs that lower blood pressure are given to relatively few stroke victims. PROGRESS investigators now recommend that these drugs be given to all stroke patients.

Unlike aspirin, which is associated with an increased risk for bleeding, these drugs have no effect on bleeding risk, so they can be used even after strokes caused by bleeding into the brain. They are taken only once daily and cause few side effects other than occasional cough or excessively low blood pressure.

Robert A. Kloner, MD, adds that it is not clear why the drugs protect against stroke, but they may stabilize and relax the blood vessel wall, improving blood flow. "Another possibility is that our definition of high blood pressure is wrong," he says, noting that optimal blood pressure may actually be lower than "normal" blood pressure defined by looking at large population groups.

Kloner, a professor of medicine at the University of Southern California in Los Angeles, provided his independent comments about the study to WebMD. He says at present, experts are unable to say if the protective effect is unique to perindopril and indapamide, or if other medications that lower blood pressure would also protect against further stroke.

The PROGRESS study was supported by grants from medical research agencies in Australia and New Zealand, together with French pharmaceutical company Servier.

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