The PROGRESS trial three years later: HOPE trial may shed some light

doi:10.1136/bmj.329.7479.1403-d

BMJ 2004;329:1403-1404 (11 December), doi:10.1136/bmj.329.7479.1403-d

Letter

The PROGRESS trial three years later

HOPE trial may shed some light

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

EDITOR—Wennberg and Zimmermann are correct in pointingout that it is simplistic, and potentially misleading, to interpretPROGRESS as indicating that patients with stroke benefit fromthe combination of perindopril and indapamide.¹ In applyingthese results clinically, doctors need to know whether the benefitin stroke reduction is due mainly to indapamide or to some synergisticeffect of the two. After all, given the prevalence of polypharmacyand the cost, why give two drugs when one might suffice?

To sort out this question it is helpful to compare the resultsof PROGRESS with those of HOPE, in which ramipril was foundto cause a significant relative risk reduction in stroke of32% (95% confidence interval 16% to 44%) compared with placebo.²This reduction was sustained for fatal and non-fatal strokesand for ischaemic strokes.³

How are clinicians to reconcile the beneficial effect of ramiprilmonotherapy in HOPE with . . . [Full text of this article]

John Attia, associate professor, epidemiology

John.Attia@newcastle.edu.au, Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW 2300, Australia

Catherine D'Este, associate professor biostatistics, Christopher R Levi, conjoint senior lecturer

Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW 2300, Australia

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