Blood Pressure–Lowering Treatment With Candesartan in Patients With Acute Hemorrhagic Stroke

Someday our medical teams will figure out exactly what should be done for blood pressure lowering post-stroke. Maybe create a f*cking protocol and publish it for the world to see. Other research here:

1. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset

 2. Early Intensive Blood-Pressure Lowering Improves Recovery in Patients With Acute Intracerebral Haemorrhage

 3.  Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

 4. External Counterpulsation Augments Blood Pressure and Cerebral Flow Velocities in Ischemic Stroke Patients With Cerebral Intracranial Large Artery Occlusive Disease

5.  The One Benefit Of High Blood Pressure? It May Prevent Dementia

6.  Stopping Pre-Stroke Antihypertensive Medication Advised During Acute Stroke 

7.  Mild induced hypertension improves blood flow and oxygen metabolism in transient focal cerebral ischemia

8.  Low Diastolic Pressure Linked to Brain Atrophy 

9.  New Treatment for Stroke Set to Increase Chances of Recovery - haemorrhage blood pressure lowering

Blood Pressure–Lowering Treatment With Candesartan in Patients With Acute Hemorrhagic Stroke

1. Mirza Jusufovic, MD,
2. Else C. Sandset, MD, PhD,
3. Philip M.W. Bath, FRCP, FESO and
4. Eivind Berge, MD, PhD;
5. on behalf of the Scandinavian Candesartan Acute Stroke Trial Study Group

+ Author Affiliations

1. From the Departments of Neurology (M.J., E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.).

1. Correspondence to Eivind Berge, MD, PhD, Oslo University Hospital, Department of Internal Medicine, Kirkeveien 166, NO-0407 Oslo, Norway. E-mail eivind.berge@medisin.uio.no

Abstract

Background and Purpose—Early and intensive blood pressure–lowering treatment seems to be beneficial in patients with acute hemorrhagic stroke and high blood pressure. We wanted to see if similar benefits can be shown from a later and more gradual blood pressure lowering, using data from the Scandinavian Candesartan Acute Stroke Trial (SCAST).

Methods—SCAST was a randomized- and placebo-controlled, double-masked trial of candesartan given for 7 days, in 2029 patients with acute stroke and systolic blood pressure ≥140 mm Hg. We assessed the effects of candesartan in the 274 patients with hemorrhagic stroke, using the trial’s 2 coprimary effect variables: the composite vascular end point of vascular death, stroke or myocardial infarction, and functional outcome at 6 months, according to the modified Rankin Scale. We used Cox proportional hazards models and ordinal regression for analysis and adjusted for key, predefined prognostic variables.

Results—There was no association between treatment with candesartan and risk of vascular events (17 of 144 [11.8%] versus 13 of 130 [10.0%]; hazard ratio, 1.36; 95% confidence interval, 0.65–2.83; P=0.41). For functional outcome we found evidence of a negative effect of candesartan (common odds ratio, 1.61; 95% confidence interval, 1.03–2.50; P=0.036).

Conclusions—There was no evidence that blood pressure–lowering treatment with candesartan is beneficial during the first week of hemorrhagic stroke. Instead, there were signs that such treatment may be harmful, but this needs to be verified in larger studies.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00120003.