Reductions in the risks of recurrent stroke in patients with and without diabetes

The PROGRESS Trial

Karine Berthet, Bruce C. Neal, John P. Chalmers, Stephen W. MacMahon, Marie Germaine Bousser, Sam A. Colman, Mark Woodward, C. Anderson, J. Cutler, S. Davis, G. Donnan, L. Hansson, S. Harrap, K. Lees, L. Liu, G. Mancia, B. Neal, T. Omae, J. Reid, A. Rodgers & 14 others R. Sega, A. Terent, C. Tzourio, C. Warlow, N. Anderson, C. Bladin, B. Chambers, G. Gordon, N. Sharpe, R. Collins, P. Sandercock, J. Simes, P. Sleight, S. Colman

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

Background: Analyses of the risks of stroke were conducted for subjects with and without diabetes, participating in a randomized, double-blind, placebo-controlled trial of a perindopril-based blood pressure lowering regimen in 6105 people with prior stroke or transient ischaemic attack (TIA), followed for a median of 3.9 years. Findings: Seven hundred and sixty-one patients had diabetes at baseline. Diabetes increased the risk of recurrent stroke by 35% (95% CI 10-65%) principally through an effect on ischaemic stroke (1.53, 95% CI 1.23-1.90). Active treatment reduced blood pressure by 9.5/4.6 mmHg in patients with diabetes and by 8.9/3.9 mmHg in patients without diabetes. The proportional risk reductions achieved for stroke in patients with diabetes, 38% (95% CI 8-58%), and patients without diabetes, 28% (95% CI 16-39%), were not significantly different (p homogeneity = 0.5). The absolute reduction in the risk of recurrent stroke in the patients with diabetes was equivalent to one stroke avoided among every 16 (95% CI 9-111) patients treated for 5 years. Conclusions: Diabetes is an important risk factor for stroke in patients with established cerebrovascular disease. Treatment with the ACE inhibitor perindopril with discretionary use of the diuretic indapamide produced reductions in the risk of recurrent stroke in patients with diabetes that were at least as great as those achieved in patients without diabetes.

Original languageEnglish
Pages (from-to)7-13
Number of pages7
JournalBlood Pressure
Volume13
Issue number1
DOIs
Publication statusPublished - 2004

Fingerprint

Risk Reduction Behavior
Stroke
Perindopril
Indapamide
Blood Pressure
Cerebrovascular Disorders
Numbers Needed To Treat
Transient Ischemic Attack
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Placebos

Keywords

  • Blood pressure lowering
  • Cerebrovascular disease and diabetes
  • Cognitive function
  • Indapamide
  • Perindopril
  • Stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Berthet, K., Neal, B. C., Chalmers, J. P., MacMahon, S. W., Bousser, M. G., Colman, S. A., ... Colman, S. (2004). Reductions in the risks of recurrent stroke in patients with and without diabetes: The PROGRESS Trial. Blood Pressure, 13(1), 7-13. https://doi.org/10.1080/08037050410029605

Reductions in the risks of recurrent stroke in patients with and without diabetes : The PROGRESS Trial. / Berthet, Karine; Neal, Bruce C.; Chalmers, John P.; MacMahon, Stephen W.; Bousser, Marie Germaine; Colman, Sam A.; Woodward, Mark; Anderson, C.; Cutler, J.; Davis, S.; Donnan, G.; Hansson, L.; Harrap, S.; Lees, K.; Liu, L.; Mancia, G.; Neal, B.; Omae, T.; Reid, J.; Rodgers, A.; Sega, R.; Terent, A.; Tzourio, C.; Warlow, C.; Anderson, N.; Bladin, C.; Chambers, B.; Gordon, G.; Sharpe, N.; Collins, R.; Sandercock, P.; Simes, J.; Sleight, P.; Colman, S.

In: Blood Pressure, Vol. 13, No. 1, 2004, p. 7-13.

Research output: Contribution to journalArticle

Berthet, K, Neal, BC, Chalmers, JP, MacMahon, SW, Bousser, MG, Colman, SA, Woodward, M, Anderson, C, Cutler, J, Davis, S, Donnan, G, Hansson, L, Harrap, S, Lees, K, Liu, L, Mancia, G, Neal, B, Omae, T, Reid, J, Rodgers, A, Sega, R, Terent, A, Tzourio, C, Warlow, C, Anderson, N, Bladin, C, Chambers, B, Gordon, G, Sharpe, N, Collins, R, Sandercock, P, Simes, J, Sleight, P & Colman, S 2004, 'Reductions in the risks of recurrent stroke in patients with and without diabetes: The PROGRESS Trial', Blood Pressure, vol. 13, no. 1, pp. 7-13. https://doi.org/10.1080/08037050410029605
Berthet, Karine ; Neal, Bruce C. ; Chalmers, John P. ; MacMahon, Stephen W. ; Bousser, Marie Germaine ; Colman, Sam A. ; Woodward, Mark ; Anderson, C. ; Cutler, J. ; Davis, S. ; Donnan, G. ; Hansson, L. ; Harrap, S. ; Lees, K. ; Liu, L. ; Mancia, G. ; Neal, B. ; Omae, T. ; Reid, J. ; Rodgers, A. ; Sega, R. ; Terent, A. ; Tzourio, C. ; Warlow, C. ; Anderson, N. ; Bladin, C. ; Chambers, B. ; Gordon, G. ; Sharpe, N. ; Collins, R. ; Sandercock, P. ; Simes, J. ; Sleight, P. ; Colman, S. / Reductions in the risks of recurrent stroke in patients with and without diabetes : The PROGRESS Trial. In: Blood Pressure. 2004 ; Vol. 13, No. 1. pp. 7-13.
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T1 - Reductions in the risks of recurrent stroke in patients with and without diabetes

T2 - The PROGRESS Trial

AU - Berthet, Karine

AU - Neal, Bruce C.

AU - Chalmers, John P.

AU - MacMahon, Stephen W.

AU - Bousser, Marie Germaine

AU - Colman, Sam A.

AU - Woodward, Mark

AU - Anderson, C.

AU - Cutler, J.

AU - Davis, S.

AU - Donnan, G.

AU - Hansson, L.

AU - Harrap, S.

AU - Lees, K.

AU - Liu, L.

AU - Mancia, G.

AU - Neal, B.

AU - Omae, T.

AU - Reid, J.

AU - Rodgers, A.

AU - Sega, R.

AU - Terent, A.

AU - Tzourio, C.

AU - Warlow, C.

AU - Anderson, N.

AU - Bladin, C.

AU - Chambers, B.

AU - Gordon, G.

AU - Sharpe, N.

AU - Collins, R.

AU - Sandercock, P.

AU - Simes, J.

AU - Sleight, P.

AU - Colman, S.

PY - 2004

Y1 - 2004

N2 - Background: Analyses of the risks of stroke were conducted for subjects with and without diabetes, participating in a randomized, double-blind, placebo-controlled trial of a perindopril-based blood pressure lowering regimen in 6105 people with prior stroke or transient ischaemic attack (TIA), followed for a median of 3.9 years. Findings: Seven hundred and sixty-one patients had diabetes at baseline. Diabetes increased the risk of recurrent stroke by 35% (95% CI 10-65%) principally through an effect on ischaemic stroke (1.53, 95% CI 1.23-1.90). Active treatment reduced blood pressure by 9.5/4.6 mmHg in patients with diabetes and by 8.9/3.9 mmHg in patients without diabetes. The proportional risk reductions achieved for stroke in patients with diabetes, 38% (95% CI 8-58%), and patients without diabetes, 28% (95% CI 16-39%), were not significantly different (p homogeneity = 0.5). The absolute reduction in the risk of recurrent stroke in the patients with diabetes was equivalent to one stroke avoided among every 16 (95% CI 9-111) patients treated for 5 years. Conclusions: Diabetes is an important risk factor for stroke in patients with established cerebrovascular disease. Treatment with the ACE inhibitor perindopril with discretionary use of the diuretic indapamide produced reductions in the risk of recurrent stroke in patients with diabetes that were at least as great as those achieved in patients without diabetes.

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KW - Blood pressure lowering

KW - Cerebrovascular disease and diabetes

KW - Cognitive function

KW - Indapamide

KW - Perindopril

KW - Stroke

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