We read with interest the excellent review by Jacoby and Rader1 defining the role of the renin-angiotensin system in the pathogeneses of vascular disease. Six clinical trials in patients with normal ejection fractions were presented as evidence for the vascular protective effects of ACE inhibitors.
We would like to point out that the impressive benefit seen in patients with prior strokes in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) occurred only after the diuretic indapamide was added, and no benefit was seen from perindopril alone.2
Carter WH, Rosencrance G. Role of the Renin-Angiotensin System in the Pathogenesis of Vascular Disease. Arch Intern Med. 2003;163(22):2791. doi:10.1001/archinte.163.22.2791-a