Medknow Publications on behalf of the Neurological Society of India
Abstract
Background: Although the risk reduction of recurrent stroke with
angiotensin converting enzyme-inhibitors with or without a diuretic has
been demonstrated under randomized double blind conditions of the
PROGRESS study, it is unclear whether the benefit is reflected in
primary care practice and in populations with different demographic and
clinical characteristics. Aim: To assess the effect and
acceptability of perindopril with or without indapamide prevention of
recurrent stroke, as reflected by its incidence. Setting and Design:
Multicentre, prospective, observational study in the setting of primary
care throughout India. Materials and Methods: Patients with a stable
stroke or transient ischaemic attack (TIA) received a 12-month
perindopril ± indapamide-based regimen, similar to that used in
PROGRESS. The principal outcome was the annual incidence of recurrent
stroke. Statistical Analysis: Summary statistics and the Kaplan-Meier
procedure. Results: The mean age of 298 patients was 58.3 years
(SD=12.6). 229 (77.5%) had an ischaemic stroke; 231 (77.5%) were
hypertensive; 200 (85.5%) were receiving aspirin and 81 (27.2%)
statins. During the 12-month perindopril-based treatment, there were 8
(2.7%) recurrent strokes, with a Kaplan-Meier estimate of strokes plus
TIA of 3.3% (95% CI, 1.0-5.6). Conclusions: The incidence of
recurrent stroke is similar to that observed under double blind
randomized conditions in the treatment arm of the PROGRESS study. This
suggests that perindopril ± indapamide-based prevention may be
effective in reducing risk of recurrent stroke, (although the
uncontrolled study design does not actually demonstrate this), in the
setting of day-to-day clinical practice and among patients with
different demographic and clinical characteristics than the PROGRESS
population