Dataset Information

Telmisartan to prevent recurrent stroke and cardiovascular events.

ABSTRACT:

Background

Prolonged lowering of blood pressure after a stroke reduces the risk of recurrent stroke. In addition, inhibition of the renin-angiotensin system in high-risk patients reduces the rate of subsequent cardiovascular events, including stroke. However, the effect of lowering of blood pressure with a renin-angiotensin system inhibitor soon after a stroke has not been clearly established. We evaluated the effects of therapy with an angiotensin-receptor blocker, telmisartan, initiated early after a stroke.

Methods

In a multicenter trial involving 20,332 patients who recently had an ischemic stroke, we randomly assigned 10,146 to receive telmisartan (80 mg daily) and 10,186 to receive placebo. The primary outcome was recurrent stroke. Secondary outcomes were major cardiovascular events (death from cardiovascular causes, recurrent stroke, myocardial infarction, or new or worsening heart failure) and new-onset diabetes.

Results

The median interval from stroke to randomization was 15 days. During a mean follow-up of 2.5 years, the mean blood pressure was 3.8/2.0 mm Hg lower in the telmisartan group than in the placebo group. A total of 880 patients (8.7%) in the telmisartan group and 934 patients (9.2%) in the placebo group had a subsequent stroke (hazard ratio in the telmisartan group, 0.95; 95% confidence interval [CI], 0.86 to 1.04; P=0.23). Major cardiovascular events occurred in 1367 patients (13.5%) in the telmisartan group and 1463 patients (14.4%) in the placebo group (hazard ratio, 0.94; 95% CI, 0.87 to 1.01; P=0.11). New-onset diabetes occurred in 1.7% of the telmisartan group and 2.1% of the placebo group (hazard ratio, 0.82; 95% CI, 0.65 to 1.04; P=0.10).

Conclusions

Therapy with telmisartan initiated soon after an ischemic stroke and continued for 2.5 years did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes. (ClinicalTrials.gov number, NCT00153062.)

SUBMITTER: Yusuf S

PROVIDER: S-EPMC2714258 | biostudies-literature | 2008 Sep

REPOSITORIES: biostudies-literature

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Publications

Telmisartan to prevent recurrent stroke and cardiovascular events.

Yusuf Salim S Diener Hans-Christoph HC Sacco Ralph L RL Cotton Daniel D Ounpuu Stephanie S Lawton William A WA Palesch Yuko Y Martin Reneé H RH Albers Gregory W GW Bath Philip P Bornstein Natan N Chan Bernard P L BP Chen Sien-Tsong ST Cunha Luis L Dahlöf Björn B De Keyser Jacques J Donnan Geoffrey A GA Estol Conrado C Gorelick Philip P Gu Vivian V Hermansson Karin K Hilbrich Lutz L Kaste Markku M Lu Chuanzhen C Machnig Thomas T Pais Prem P Roberts Robin R Skvortsova Veronika V Teal Philip P Toni Danilo D VanderMaelen Cam C Voigt Thor T Weber Michael M Yoon Byung-Woo BW

The New England journal of medicine 20080827 12

<h4>Background</h4>Prolonged lowering of blood pressure after a stroke reduces the risk of recurrent stroke. In addition, inhibition of the renin-angiotensin system in high-risk patients reduces the rate of subsequent cardiovascular events, including stroke. However, the effect of lowering of blood pressure with a renin-angiotensin system inhibitor soon after a stroke has not been clearly established. We evaluated the effects of therapy with an angiotensin-receptor blocker, telmisartan, initiate ...[more]

PMID: 18753639

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Dataset Information

Telmisartan to prevent recurrent stroke and cardiovascular events.

Background

Methods

Results

Conclusions

Publications

Telmisartan to prevent recurrent stroke and cardiovascular events.

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