The Pharmaceutical Journal
Vol 268 No 7204 p895-899
29 June 2002

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Perindopril protects against dementia

A Perindopril-based regimen reduces the chance of patients developing dementia and severe cognitive decline following a stroke, even if they suffer recurrent stroke, a new analysis of data from PROGRESS (perindopril protection against recurrent stroke study) shows.

The analysis examined the risk of developing neurological problems following stroke among 6,105 people randomly assigned to receive perindopril (Coversyl) 4mg plus indapamide 2.5 mg where indicated, or to placebo. The primary endpoint of the trial, reported last year, found that the risk of recurrent stroke or heart attack was reduced by one quarter to one third among normotensive and hypertensive patients treated with perindopril plus indapamide compared with placebo (PJ, 23 June 2001, p842).

During a follow-up period of four years, researchers assessed the rate at which dementia and severe cognitive decline developed among study participants. Overall, patients allocated perindopril-based therapy were 34 per cent less likely to develop dementia after recurrent stroke compared with patients allocated placebo. The risk of severe cognitive decline among perindopril-treated patients fell 19 per cent overall compared with the placebo group, and the active treatment cut the risk of severe cognitive decline among those who suffered a recurrent stroke by 45 per cent compared with placebo.

Dr Christophe Tzourio, Salpetriere Hospital, Paris, said the data underlined the recommendation that perindopril-based therapy should be considered routinely for all patients with cerebrovascular disease. Presenting the data at the International Society of Hypertension meeting in Prague earlier this week, he said: "PROGRESS provides the most compelling evidence to date about the positive effects of blood pressure lowering on the risks of dementia and severe cognitive function."