Secondary prevention for stroke and transient ischaemic attacks: PROGRESS is about reducing blood pressure, not promoting drugs

doi:10.1136/bmj.328.7444.896-b

BMJ 2004;328:896-897 (10 April), doi:10.1136/bmj.328.7444.896-b

Letter

Secondary prevention for stroke and transient ischaemic attacks

PROGRESS is about reducing blood pressure, not promoting drugs

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

EDITOR—In his editorial Muir argues for the combinationof perindopril and indapamide as preferred agents for loweringblood pressure after stroke or transient ischaemic attack onthe basis of the perindopril protection against recurrent strokestudy (PROGRESS).¹ Is this justified? PROGRESS did not compareregimens; other evidence shows that lowering blood pressureis more important than choice of drug.²

Muir says that several factors favour the PROGRESS regimen.

Firstly, the combination was well tolerated. Without makingcomparisons with other drugs this seems a sweeping conclusion.

Secondly, he says that dose titration of perindopril is rapidand simpler than other angiotensin converting enzyme inhibitors.This is more relevant to heart failure than hypertension.

Thirdly, he claims that perindopril may reduce blood pressurewithout impairing global cerebral blood flow, even in patientswith moderate to severe carotid stenosis. Where is the evidenceon how this compares with other drugs?