A high medical need

Patients who have already suffered a stroke are at a high risk of recurrence. Among those that survive a first stroke, 8% of patients suffer a further stroke within 1 year, and 17% of patients experience another event in the following 5-year period. There is therefore a high medical need for a safe and effective treatment for secondary stroke prevention to limit the damage suffered by patients who have already had an attack.

Blood pressure is key

Risk of recurrent stroke is influenced by several factors. In particular, hypertension following a stroke is associated with a poor outcome. Risk of recurrent stroke is much higher in hypertensive patients than in those with normal blood pressure. Control of blood pressure following a stroke is therefore a major factor in preventing the occurrence of a second stroke.

Building on promising results

In September 2001, results from a major clinical trial called PROGRESS (Perindopril pROtection aGainst REcurrent Stroke Study) showed that the risk of secondary stroke was significantly reduced by an angiotensin-converting enzyme (ACE) inhibitor combined with a diuretic. Since then, there have been no further studies to compare the effect of other agents in the prevention of secondary stroke, and no data are currently available to show which antihypertensives are preferable for the prevention of recurrent stroke. Agents that interact with the renin–angiotensin–aldosterone system (RAAS), such as ACE inhibitors and angiotensin-II receptor antagonist (AIIAS), could be of particular benefit for those with pre-existing cardiovascular disease, in addition to blood pressure reduction.