Neurology

Question 1

What did the PROGRESS trial suggest?
(perindopril+indapamide post stroke)

Baselines:
- BP 147/86
- Age 64
- Ethnicity Asian 39%
- Ischaemic stroke 71%
Rx:
- Perindopril 4mg + indapamide 2.5mg daily

Answer 1

• Recurrent stroke RR reduction 28%
• Reduced MACE RR reduction 26%
• Recurrent stroke: combo perindopril+indapamide RR reduction 43% vs perindopril only 5%
• Should not be overly aggressive with BP lowering in large vessel stenosis (eg carotid stenosis) as may precipitate watershed infarcts

Question 2

What did the RE-SPECT ESUS study demonstrate?

Dabigatran vs aspirin as secondary prevention in cryptogenic stroke

Answer 2

• Dabigatran statistically insignificant benefit vs aspirin for recurrent ischaemic stroke HR 0.84 (95% CI 0.68-1.03)
• Major bleeding HR 1.19 (95% CI 0.85-1.66)