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To the Editor: In their Scientific Review article about stroke prevention, Dr Straus and colleagues¹ stated that the benefits of antihypertensive therapy are related to the degree of blood pressure lowering, irrespective of which drugs are used. Although the authors cite the PROGRESS trial² as supporting this position, we think that the results may suggest a different interpretation.

According to the PROGRESS authors, a 5-mm Hg decrease in systolic blood pressure (SBP) with perindopril alone should have reduced the risk of stroke recurrence by 14% in their population with a history of stroke. Instead, however, the authors found that this degree of blood pressure lowering translated into only a 5% reduction in the risk of stroke, yielding a net 9% blood pressure–independent stroke-producing effect. In contrast, a 12-mm Hg decrease in SBP with perindopril plus indapamide, which would have been predicted to produce a stroke risk reduction of 33%, . . . [Full Text of this Article]

Albert Fournier, MD
Department of Nephrology

Roxana Oprisiu, MD
Department of Geriatrics

Michel Andrejak, MD
Pharmacology Laboratory
Centre Hospitalier Universitaire d'Amiens
Amiens, France

Jean Michel Achard, MD, PhD
Department of Physiology
Centre Hospitalier Universitaire Limoges
Limoges, France

Leonardo Fernandez, MD, PhD
Department of Pathology
Yale Medical School
New Haven, Conn

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