BMJ  2004;329:968-970 (23 October), doi:10.1136/bmj.329.7472.968

Education and debate

The PROGRESS trial three years later: time for a balanced report of effectiveness

¹ Department of Medicine, University of Toronto, University Health Network, Toronto, ON, Canada M5T 2S8

Has the use of the phrase "perindopril based blood pressure lowering regimen" resulted in an oversimplistic and hence inaccurate interpretation of the results of the PROGRESS trial creeping into the literature and clinical practice?

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

Introduction

Any doctor who keeps up to date with the stroke literature will be familiar with PROGRESS—the perindopril protection against recurrent stroke study,¹ a clinical trial which had resulted, by February 2004, in more than 35 ancillary publications. The aim of the study was to "resolve clinical uncertainty about the efficacy and safety of routine blood-pressure-lowering therapy for individuals with a history of stroke or transient ischemic attack."¹ The trial found that blood pressure lowering was safe and effective, but three years after its publication, the optimal antihypertensive regimen for secondary stroke prevention remains unclear. The title of the study, together with its results as reported, may lead the unwary reader to conclude that perindopril used alone protects against recurrence of stroke. Although this was actually not a finding of PROGRESS, the study design and data presentation obfuscate this fact rather than making it clear.

Design of the trial

The PROGRESS trial had a "flexible" . . . [Full text of this article]

Reaction to results

Further publications of PROGRESS data

Authors' and readers' responsibilities

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This article has been cited by other articles:

• Mant, J., McManus, R. J, Hare, R. (2006). Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study. BMJ 332: 635-637 [Abstract] [Full text]  
• Wennberg, R., Zimmermann, C. (2005). Perindopril monotherapy and PROGRESS in Europe. BMJ 331: 235-236 [Full text]  
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• Penston, J. (2005). Users' guide to detecting misleading claims in research: Misleading claims may be symptom of even more serious flaws. BMJ 330: 145-145 [Full text]  
• Hackam, D. G (2004). The PROGRESS trial three years later: Clear and accurate interpretations of studies are needed. BMJ 329: 1404-1404 [Full text]  
• Attia, J., D'Este, C., Levi, C. R (2004). The PROGRESS trial three years later: HOPE trial may shed some light. BMJ 329: 1403-1404 [Full text]  
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Rapid Responses:

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bmj.com, 25 Oct 2004 [Full text]

A reminder of the flaws of PROGRESS

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bmj.com, 29 Oct 2004 [Full text]

Review makes clear what has been obscured

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