Telmisartan to prevent recurrent stroke and cardiovascular events

Yusuf, Salim and Diener, Hans-Christoph and Sacco, Ralph L. and Cotton, Daniel and Ounpuu, Stephanie and Lawton, William A. and Palesch, Yuko and Martin, Renée H. and Albers, Gregory W. and Bath, Philip M.W. and Bornstein, Natan and Chan, Bernard P.L. and Chen, Sien-Tsong and Cunha, Luis and Dahlöf, Björn and De Keyser, Jacques and Donnan, Geoffrey A. and Estol, Conrado and Gorelick, Philip and Gu, Vivian and Hermansson, Karin and Hillbrich, Lutz and Kaste, Markku and Lu, Chuanzhen and Machnig, Thomas and Pais, Prem and Roberts, Robin and Skvortsova, Veronika and Teal, Philip and Toni, Danilo and Vandermaelen, Cam and Voight, Thor and Weber, Michael and Yoon, Byung-Woo (2008) Telmisartan to prevent recurrent stroke and cardiovascular events. New England Journal of Medicine, 359 (12). pp. 1225-1237. ISSN 0028-4793

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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 followup

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.)

Item Type: Article
Schools/Departments: University of Nottingham UK Campus > Faculty of Medicine and Health Sciences > School of Medicine > Division of Clinical Neuroscience
Depositing User: Sayers, Hazel
Date Deposited: 11 Sep 2008 13:33
Last Modified: 16 Aug 2013 07:23
URI: http://eprints.nottingham.ac.uk/id/eprint/952

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