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Vascular Protection of ACE Inhibitors
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In their enthusiastic review on the renin-angiotensin system and atherothrombotic disease,1 Jacoby and Rader state that
. . . the PROGRESS (Perindopril Protection Against Recurrent Stroke Study) found that angiotensin-converting enzyme (ACE) inhibition in 6105 patients with a history of cardiovascular accidents or transient ischemic attacks reduced the secondary outcome of cardiac death or acute MI. . . .
This statement represents a misinterpretation of the PROGRESS data.2 Despite lowering systolic pressure by 5 mm Hg, monotherapy with perindopril did not reduce the primary end point or the secondary end point in this study, as was clearly emphasized by Staessen et al.3 Only when indapamide was added to perindopril was there a significant reduction in these end points. In contrast, for the same systolic pressure reduction of 5 mm Hg, monotherapy with indapamide reduced the risk of strokes by an impressive 29% in 2841 patients in the Post-stroke Antihypertensive Treatment . . . [Full Text of this Article]
Franz H. Messerli, MD
New Orleans, La
RELATED ARTICLE
Vascular Protection of ACE Inhibitors—Reply
Douglas S. Jacoby and Daniel J. Rader
Arch Intern Med. 2003;163(22):2792-2793.
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