Secondary prevention for stroke and transient ischaemic attacks

doi:10.1136/bmj.328.7435.297

BMJ 2004;328:297-298 (7 February), doi:10.1136/bmj.328.7435.297

Editorial

Secondary prevention for stroke and transient ischaemic attacks

Even patients with normal blood pressure and cholesterol levelsmay benefit

The first 150 words of the full text of this article appear below.

Two key trials—the perindopril protection against recurrentstroke study (PROGRESS)¹ and the heart protection study (HPS)²—haveexpanded options for secondary prevention after stroke or transientischaemic attack and have also mandated a fundamental changein thinking about risk. The concepts of hypertension and hypercholesterolaemiamay now be irrelevant or even harmful in this population.^w1

In observational epidemiology studies no demonstrable floorexists for the relation between blood pressure and risk of stroke,with risk continuing to halve for every 10 mm Hg fall in diastolicpressure even at conventionally normotensive values.³ Meta-analysesof small trials of antihypertensive treatment in patients witha stroke showed a 28% reduction in relative risk for strokeregardless of baseline blood pressure.⁴ ^w2 This was supportedby the post-stroke antihypertensive study (PATS),⁵ in whichindapamide gave an absolute reduction in stroke risk by 2.9%compared with placebo over three years (number needed to treat(NNT) . . . [Full text of this article]

Keith W Muir, senior lecturer in neurology

Division of Clinical Neurosciences, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF (k.muir@clinmed.gla.ac.uk)

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