my personal edition > neurologic other > news


  E-Mail this DGReview to a colleague

DGReview

Perindopril/Indapamide Therapy May Help Reduce Dementia Risk In Patients With Cerebrovascular Disease

Lowering blood pressure with perindopril and indapamide therapy may reduce the risk of dementia and cognitive impairment in patients with cerebrovascular disease, according to new findings from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS).

Previous observational studies have demonstrated that elevated blood pressure and a history of cerebrovascular disease are each strongly associated with the long-term risks of dementia and cognitive impairment.

Christophe Tzourio, MD, PhD, with the INSERM (National Institute of Health and Medical Research), Paris, France, and colleagues conducted PROGRESS, a prospective, randomized trial conducted among 6105 people with prior stroke or transient ischemic attack.

Participants received either perindopril and indapamide (in the case that a diuretic was neither indicated nor contraindicated) or matching placebo(s). The presence of dementia was evaluated using DSM-IV criteria, and cognitive decline was determined by a decline of 3 or more points in the Mini-Mental State Examination score.

During a mean follow-up of 3.9 years, dementia was documented in 193 (6.3%) of the 3051 randomized participants in the actively treated group and 217 (7.1%) of the 3054 participants in the placebo group, for a non-significant relative risk reduction of 12% (95% confidence interval, -8% to 28%; p=0.2).

In contrast, cognitive decline was significantly reduced in the active treatment group. A decline occurred in 9.1% of the actively treated group and 11.0% of the placebo group, indicating a reduced risk of 19% (95% confidence interval, 4% to 32%; (p=0.01).

Likewise, in the presence of recurrent stroke, the composite outcome of dementia was reduced by 34% (95% confidence interval, 3% to 55%; p=0.03) and that of cognitive decline was reduced by 45% (95% confidence interval, 21% to 61%; p<0.001).

"This study has confirmed the beneficial effects of a preventive strategy based on blood pressure lowering," Dr. Tzourio and colleagues conclude. "These benefits, when added to those previously reported, provide further support for the recommendation that blood pressure lowering with perindopril and indapamide be considered for all patients with a history of stroke or transient ischemic attack."
Arch Intern Med 2003;163:9:1069-1075. "Effects of Blood Pressure Lowering With Perindopril and Indapamide Therapy on Dementia and Cognitive Decline in Patients With Cerebrovascular Disease"

E-Mail this DGReview to a colleague

To print, use this version