PRoFESS^®

Prevention Regimens For Effectively avoiding Second Strokes - A landmark study in cerebrovascular and cardiovascular protection

Why conduct this study?

Stroke is the second most common cause of death worldwide, accounting for more than 3 million deaths in women and 2.5 million deaths in men each year. The risk of recurrent stroke or a transient ischaemic attack remains at 5% to 15% per year. Thus, the prevention of a recurrent stroke event is an important therapeutic goal.^1,2

Hypertension is one of the main risk factors for the development of stroke. Cohort studies have shown that the risk of stroke correlates with an increase in blood pressure. An early morning surge in blood pressure denotes an additional risk factor for stroke.^3,4

Angiotensin II, acting via the AT₁ receptor, mediates the role of additional risk factors such as atherosclerosis, endothelial dysfunction, thrombosis and atrial fibrillation. Thus blocking this receptor is potentially of great therapeutic benefit, not just in terms of managing hypertension but multiple cardiovascular events

In contrast to angiotensin-converting enzyme (ACE) inhibitors, MICARDIS^® provides complete blockade of the AT₁ receptor while allowing (potentially beneficial) activation of the AT₂ receptor. This arbitrative difference in the mode of action between angiotensin receptor blockers (ARBs) and ACE inhibitors may extend to a difference in vascular protective properties.

Unlike other ARBs, MICARDIS^® crosses the blood–brain barrier and the antihypertensive efficacy is maintained into the early morning hours, when the risk of stroke and other cardiovascular events is highest. Until now, the blood-pressure-independent effects of ARBs in preventing a second stroke have not been investigated.

The PRoFESS^® trial – a landmark study in cerebrovascular and cardiovascular protection – was designed to answer this question.² It is the world’s largest secondary stroke prevention trial, and includes 20,333 high-risk patients from 35 countries.

The aims of the PRoFESS^® study are to investigate whether:

• MICARDIS^®, in addition to standard stroke prevention therapy, will further reduce the risk of recurrent stroke.
• Extended-release dipyridamole plus aspirin is superior to clopidogrel in secondary stroke prevention.

References