OBJECTIVESTo investigate the effects of blood pressure lowering treatment on stroke recurrence among Chinese patients with previous cerebrovascular diseases.

METHODSPatients were eligible if they had a history of stroke or transient ischaemic attack (TIA) within the previous 5 years. Participants had no definite indication or contraindication for study drugs. There were no blood pressure entry criteria. This study was a large-scale randomised, double-blind, placebo controlled clinical trial. After 4 weeks run-in period, 1520 randomised patients received either ACE inhibitor-perindopril (+ diuretic-indapamide) treatment or matching placebo for 4 years. The primary study outcome was stroke event. Secondary outcomes included cardiovascular death, myocardial infarction, all-cause death and blood pressure.

RESULTSSsven hundred and sixty-two were assigned active treatment and 758 assigned placebo. The characteristics of randomised patients of active and control groups were similar. In active and control groups: 70.8% and 70.5% were male, 93.8% and 93.4% had a history of stroke (haemorrhagic or cerebral infarction). Baseline mean blood pressure in the active and control groups were 145.3 +/- 20.2/86.8 +/- 11.1 mm Hg and 145.3 +/- 20.3/87.2 +/- 10.8 mm Hg, and mean age were 63.9 +/- 7.5 and 63.8 +/- 7.7 years, respectively. Blood pressure in those assigned active treatment was reduced on average 14/6 mm Hg more than placebo at 4 years. During double-blind treatment, active treatment reduced stroke recurrence (8.8% vs 19.4%) by 55% (P < 0.001), myocardial infarction (1.4% vs 2.8%) by 48% (P = 0.070), cardiovascular mortality (3.6% vs 6.6.%) by 45% (P = 0.010), and all-cause mortality (6.3% vs 9.8%) by 36% (P = 0.010). These benefits were achieved similarly in all subgroups: male or female, middle-aged or elderly, with or without hypertensive, cerebral infarct or haemorrhagic stroke.

CONCLUSION4 years of blood pressure lowering treatment was beneficial in Chinese patients with previous cerebrovascular diseases.