Incidence of recurrent stroke in primary care during preventive treatment based on perindopril with or without indapamide

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.