Global Impact of Stroke

As the developing world becomes increasingly industrialized and urbanized, and its vast populations adopt more westernized diets and lifestyles, the burden of cardiovascular disease and disability is growing at an alarming rate. The results of prospective observational studies conducted in both western and eastern populations have established the strong association between the primary incidence of stroke and the level of blood pressure. Further, randomized clinical trials of antihypertensive therapy have demonstrated a reduction in primary stroke risk. Among persons with a history of cerebrovascular disease, data from the United Kingdom Transient Ischemic Attack Aspirin Trial (UKTIA) has demonstrated a similar relationship between blood pressure and secondary stroke risk. Trials of blood-pressure lowering in patients with a history of cerebrovascular disease also suggested a reduction in stroke risk. However, patients numbers in these trials were small, and the results were not conclusive. PROGRESS (Perindopril pROtection aGainst Recurrent Stroke Study) is a large, randomized, double-blind, controlled trial designed to provide a definitive answer to these questions. Its primary aim is to determine the effect of blood-pressure lowering on stroke incidence in patients with a history of a previous stroke or transient ischemic attack. A total of 6,105 patients were randomized to receive perindopril (plus indapamide) or placebo in seven regions of the world. The current mean follow-up period exceeds 30 months, and a total follow-up period of at least 4 years is planned. Secondary outcomes include the incidence of other major cardiovascular events, such as myocardial infarction, and of cognitive decline and dementia. Both the major event rate and the degree of adherence to randomized therapy exceed initial projections, which suggests that the study should have the power to achieve its main objectives by the planned completion date of 2001.