The PROGRESS trial three years later: time for a balanced report of effectiveness

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Abstract
Any doctor who keeps up to date with the stroke literature will be familiar with PROGRESS—the perindopril protection against recurrent stroke study,1 a clinical trial which had resulted, by February 2004, in more than 35 ancillary publications. The aim of the study was to “resolve clinical uncertainty about the efficacy and safety of routine blood-pressure-lowering therapy for individuals with a history of stroke or transient ischemic attack.”1 The trial found that blood pressure lowering was safe and effective, but three years after its publication, the optimal antihypertensive regimen for secondary stroke prevention remains unclear. The title of the study, together with its results as reported, may lead the unwary reader to conclude that perindopril used alone protects against recurrence of stroke. Although this was actually not a finding of PROGRESS, the study design and data presentation obfuscate this fact rather than making it clear.

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