progress_trial [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
The Perindopril Protection Against Recurrent Stroke Study (PROGRESS) was a landmark clinical trial aimed at evaluating the effects of blood pressure reduction on the risk of recurrent stroke in individuals with a history of stroke or transient ischemic attack (TIA). 

**Study Design and Participants:**

- **Population:** The trial enrolled 6,105 participants from 172 centers across Asia, Australasia, and Europe. All participants had experienced a stroke or TIA within the previous five years.

- **Intervention:** Participants were randomly assigned to receive either active treatment or a placebo. The active treatment consisted of the angiotensin-converting enzyme (ACE) inhibitor perindopril (4 mg daily), with the addition of the diuretic indapamide at the discretion of the treating physicians.

- **Follow-Up:** The average follow-up period was four years.

**Key Findings:**

- **Blood Pressure Reduction:** The active treatment group experienced an average blood pressure reduction of 9/4 mm Hg.

- **Stroke Risk Reduction:** There was a significant reduction in the incidence of stroke among those receiving active treatment compared to the placebo group (10% vs. 14%), representing a relative risk reduction of 28% (95% CI: 17–38; p<0.0001).

- **Combination vs. Single Therapy:** Participants receiving the combination of perindopril and indapamide had a greater reduction in blood pressure (12/5 mm Hg) and a more substantial decrease in stroke risk (43% reduction) compared to those on perindopril alone, who did not exhibit a discernible reduction in stroke risk. 

**Conclusions:**
The PROGRESS trial demonstrated that a blood pressure-lowering regimen, particularly the combination of perindopril and [[indapamide]], significantly reduces the risk of recurrent stroke in individuals with a history of cerebrovascular events. These benefits were observed regardless of the participants' baseline blood pressure levels, suggesting that such a treatment approach should be considered for all patients with a history of stroke or TIA, irrespective of their initial blood pressure.