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Early antihypertensive therapy cuts risk after stroke

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LONDON (Reuters Health) – Giving antihypertensive therapy within 72 hours of ischaemic stroke can significantly reduce the risk of death and vascular complications in patients with hypertension, AstraZeneca said on Friday.

The Anglo-Swedish drug group, which has a major cardiovascular franchise, said that managing hypertension during the acute stage of strokes has been controversial up to now because of a lack of scientific data.

However, trial results now show that the risk of the combined endpoint of total mortality, cerebral complications and cardiovascular complications was cut by 47.5% when patients received the angiotensin II candesartan (Atacand).

The subjects included 342 acute stroke patients admitted to 53 centres in Germany with elevated blood pressure, defined as a single measurement of 200/110 mm Hg or higher, or an average of two separate measurements of 180 systolic and/or 105 diastolic or higher.

The study compared the effects of an early (initiated within 72 hrs post-stroke) versus delayed (>7 days post-stroke) antihypertensive treatment with candesartan or placebo.

The primary endpoint, a combination of total mortality and disability after 3 months, failed to show statistically significant differences between the drug and placebo groups.

However, the firm said that the secondary endpoint of total mortality and cerebral and vascular events during 12 months of follow-up was reached by 31 patients in the placebo group (18.7%) and 17 in the candesartan group (9.8%), a statistically significant risk reduction of 47.5%.

AstraZeneca added in a news release that candesartan is the first antihypertensive drug to show a benefit with early treatment for acute ischaemic stroke patients with hypertension.

Lead investigator Prof. J. Schrader, from St.-Josefs-Hospital, Cloppenburg, Germany said: "The new data will prove extremely useful, providing guidance to physicians involved with the daily management of patients with acute ischaemic stroke."

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