Candesartan in acute phase post stroke not beneficial, study suggests
Treating hypertension with an angiotensin-receptor blocker after acute stroke does not appear to be beneficial, study findings show.
In this study, published online in The Lancet and presented at the International Stroke Conference in Los Angeles today (11 February 2011), an international team examined whether candesartan was beneficial in patients with acute stroke and raised blood pressure.
A total of 2,029 patients from nine countries in Europe were randomised to candesartan or placebo for seven days (see Panel).
During this time, blood pressure was significantly lower in patients taking candesartan than in those on placebo (mean 147/82mmHg in the candesartan group on day 7 versus 152/84mmHg in the placebo group, P<0.0001).
But at six months, mean BP was 143/81mmHg in both groups and the risk of vascular death, myocardial infarction or stroke did not differ between the two groups (candesartan 120 events versus placebo 111 events, adjusted hazard ratio 1.09, 95 per cent confidence interval 0.84–1.41; P =0.52).
When the team looked at functional outcome, they found those on candesartan did slightly worse (adjusted common odds ratio 1.17, CI 1.00–1.38; P =0.048.
There were similar results for secondary endpoints and no evidence of a differential effect in any of the pre-specified subgroups.
Ian Rowlands, lead pharmacist for stroke services at Imperial College Healthcare NHS Trust, told PJ Online that in most cases hypertension in the acute phase post stroke would not be treated.
“There is a tendency for blood pressure to settle spontaneously in the days to weeks post stroke,” he explained, “when we could then start considering long-term blood pressure control and secondary stroke prevention.
“These results go some way to supporting the current practice of not treating raised blood pressure in acute stroke. There are other trials ongoing investigating acute stroke blood pressure management, so we await further developments.”
This randomised, placebo-controlled, double-blind trial recruited adults with acute stroke (ischaemic or haemorrhagic) and systolic blood pressure of 140mmHg or higher within 30 hours of symptom onset.
Patients were given candesartan or placebo for seven days, with doses increasing from 4mg on day 1 to 16mg on days 3 to 7. The two primary endpoints were a composite of vascular death, myocardial infarction, or stroke during the first six months, and functional outcome at six months. During this time, candesartan was the advised antihypertensive treatment.
Citation: The Pharmaceutical Journal URI: 11068436
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