Commentary

The PROGRESS trial three years later: time for more action, less distraction

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7472.970 (Published 21 October 2004) Cite this as: BMJ 2004;329:970

This article has a correction. Please see:

  1. Stephen MacMahon (smacmahon@thegeorgeinstitute.org), professor of cardiovascular medicine and epidemiology1,
  2. Bruce Neal, associate professor of medicine1,
  3. Anthony Rodgers, director2,
  4. John Chalmers, emeritus professor of medicine1
  1. 1 The George Institute for International Health, University of Sydney, PO Box M201, Sydney, NSW 2050, Australia
  2. 2 Clinical Trials Research Unit, University of Auckland, Auckland, New Zealand
  1. Correspondence to: S MacMahon

    Since the publication of the results of the PROGRESS trial, there has been much comment in the BMJ and elsewhere.1 2 Most of this acknowledges the importance of the findings for the care of patients with cerebrovascular disease. These patients are at high risk of stroke recurrence, and before the trial was completed few interventions had been proved to reduce this risk. Aspirin was known to modestly reduce the risk of recurrence of ischaemic stroke, but no treatment had been shown to reduce the frequently catastrophic recurrence of cerebral haemorrhage. This situation was changed profoundly by the results of PROGRESS, which showed that a simple blood pressure lowering regimen substantially reduced the risks of recurrent stroke,3 disability,4 and cardiac events5 across a broad range of blood pressure levels in patients with either ischaemic or haemorrhagic cerebrovascular disease.

    PROGRESS was conceived during an era in which many stroke specialists were concerned about possible risks of blood pressure lowering in patients with compromised cerebral circulation. While epidemiological evidence indicated that the lowest blood pressure levels were associated with the lowest risks of stroke recurrence,6 prevailing clinical opinion required us to allow individual doctors the discretion to determine the intensity of the blood pressure lowering regimen they provided to individual patients. …

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