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
Telmisartan to prevent recurrent stroke and cardiovascular events.
New England Journal of Medicine, 359
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.
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.
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).
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.)
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