ACE inhibitors (ACEi) seem to reduce secondary stroke in patients 'not classically' hypertensive (PROGRESS: Perindopril + Indapamide vs Perindopril alone; patients enrolled in the study did not necessarily have HTN ) and angiotensin receptor blockers (ARB) appear superior to beta-blockers for reducing mortality, even with similar blood pressure reductions (LIFE: Losartan vs Atenolol).  Major Limitation of PROGRESS Trial: Did not include the data of Indapamide alone, which perhaps may have been better than Perindopril itself. Indapamide alone may have reduced stroke by as much as 38% (43% for the combined therapy minus 5% for perindopril alone), which would be consistent with the 34% risk reduction seen with low dose diuretics in the primary prevention setting and the 29% risk reduction seen with indapamide alone in the post-stroke antihypertensive treatment study (PATS). |
Neurology > TIA / Stroke >
