BMJ  2004;328:897 (10 April), doi:10.1136/bmj.328.7444.897

Letter

Secondary prevention for stroke and transient ischaemic attacks

Author's reply

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

EDITOR—Although I agree with Ray et al that increased public recognition of stroke is necessary, it is salutary that 50% of UK stroke patients already reach hospital within six hours: thereafter, institutional barriers delay investigation and treatment.1 Although logical, acute institution of secondary preventive treatments has not been tested specifically in trials, but if beneficial, the present outpatient referral-based assessment of transient ischaemic attack must be re-evaluated, including anachronistic discrimination based on symptom duration.

Duerden may be correct that blood pressure lowering, rather than specific agents, and indapamide rather than perindopril were responsible for benefit in PROGRESS: both issues were discussed. Chemically, indapamide is a sulfonamide, not a thiazide, and differs with respect to metabolic profile, and possibly regression of left ventricular hypertrophy.2 3 Perindopril seems not to reduce global cerebral blood flow in stroke patients with carotid stenosis,4 and data are lacking for other agents. Whether these differences . . . [Full text of this article]

Keith W Muir, senior lecturer in neurology

University of Glasgow, Division of Clinical Neurosciences, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF k.muir{at}clinmed.gla.ac.uk


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