ASA: Acute Stroke Patients May Not Benefit From Candesartan

Drug not effective in patients with acute stroke and hypertension and may even be harmful

FRIDAY, Feb. 11 (HealthDay News) -- The angiotensin-receptor blocker candesartan is not beneficial for acute stroke patients with elevated blood pressure and may actually be harmful, according to a study published online Feb. 11 in The Lancet to coincide with presentation at the American Stroke Association's International Stroke Conference 2011, held from Feb. 9 to 11 in Los Angeles.

Else Charlotte Sandset, M.D., of the University of Oslo in Norway, and colleagues randomized 2,029 patients older than 18 years with acute stroke (ischemic or hemorrhagic) and systolic blood pressure of 140 mm Hg or higher to candesartan (1,017 subjects) or placebo (1,012 subjects) for seven days, with doses increasing from 4 mg on day one to 16 mg on days three to seven.

Compared to patients who received placebo, the investigators found that blood pressures were significantly lower in patients who received candesartan (147/82 mm Hg versus 152/84 mm Hg on day seven). The risk of the composite vascular end point (vascular death, myocardial infarction, or stroke during the first six months) did not differ significantly between those who received candesartan versus placebo (120 versus 111 events). The results were similar for the secondary outcome measures, including death from any cause, vascular death, ischemic stroke, hemorrhagic stroke, myocardial infarction, stroke progression, symptomatic hypotension, and renal failure. In terms of adverse events, nine patients receiving candesartan and five receiving placebo experienced symptomatic hypotension, with 18 patients receiving candesartan and 13 given placebo experiencing renal failure.

"There was no indication that careful blood-pressure lowering treatment with the angiotensin-receptor blocker candesartan is beneficial in patients with acute stroke and raised blood pressure. If anything, the evidence suggested a harmful effect," the authors write.

The study was sponsored in part by AstraZeneca and Takeda; several authors disclosed financial relationships with these and other pharmaceutical organizations.

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