ACE inhibitor plus diuretic may halt coronary events: stroke patients see 38% reduction in risk of nonfatal MIs, 26% drop in CHF risk. (Secondary Analysis of Progress Trial).

BERLIN -- Blood pressuring lowering with an ACE inhibitor and diuretic prevents coronary events and congestive heart failure in individuals with prior stroke or transient ischemic attack, regardless of their baseline blood pressure.

This key finding of a new secondary analysis of the Perindopril Protection Against Recurrent Stoke Study (PROGRESS) was greeted enthusiastically at the 24th Congress of the European-Society of Cardiology. PROGRESS randomized 6,105 hypertensive or nonhypertensive patients on standard secondary prevention regi1mens for prior stroke or TIA to placebo or 4 mg/day of the long-acting ACE inhibitor perindopril; 2.5 mg/day of the diuretic indapamide was added at the physician's discretion.

The previously reported primary end point in PROGRESS was the risk of stroke during 4 years of follow-up. The rate was 10% with active treatment and 14% in the placebo arm, for a 28% reduction in relative risk in patients on perindopril-based blood pressure lowering (Lancet 358 [9287]:1033-41, 2001).

The new secondary analysis looked at clinical outcomes in the coronary rather than cerebral vasculature. The benefits were impressive: active treatment conferred a 26% reduction in the risk of developing congestive heart failure, a 38% reduction in nonfatal acute MI, and a 26% decrease in the combined end point of nonfatal MI or death due to coronary heart disease, reported Dr. Anushka Patel of the Institute for International Health at the University of Sydney (Australia).

Moreover, the combined end point of major fatal or nonfatal coronary events, need for coronary revascularizarion, or hospitalization for unstable angina was 21% lower with active treatment than with placebo.

"One stroke, coronary event, or case of heart failure would be avoided for every 10 patients treated with a combination of perindopril and indapamide for 5 years. These absolute benefits certainly compare very favorably with other treatments commonly used for secondary prevention of vascular disease," Dr. Patel observed.

As was true for the cerebrovascular benefits cited in the first PROGRESS report, the coronary ...