Deans' stroke musings: Effects of candesartan in acute stroke on activities of daily living and level of care at 6 months

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, June 9, 2015

Effects of candesartan in acute stroke on activities of daily living and level of care at 6 months

Wow, research being published that had a negative result. I really do think that researchers know nothing about previous research in their field. There are a couple studies already suggesting that lowering blood pressure post stroke does not help.
This one:
After stroke, compared with Systolic Blood Pressure in the high range, low to normal SBP is associated with poorer mortality outcomes.
and this:
BP Lowering in Acute Stroke Flops for Improving Outcomes

and the candesartan lowering blood pressure one here:
Effects of candesartan in acute stroke on activities of daily living and level of care at 6 months

Hornslien, Astrid G.^a,c,d; Sandset, Else C.^b; Wyller, Torgeir B.^c,d; Berge, Eivind^a; on behalf of the Scandinavian Candesartan Acute Stroke Trial (SCAST) Study Group

Abstract

Objective: The Scandinavian Candesartan Acute Stroke Trial (SCAST) indicated that blood pressure-lowering treatment with candesartan in the acute phase of stroke has a negative effect on functional outcome at 6 months, measured by the modified Rankin scale. We wanted to see if similar effects can be observed on activities of daily living and level of care.

Methods: SCAST was an international multicentre, randomized and placebo-controlled trial of candesartan in 2029 patients recruited within 30 h of acute ischaemic or haemorrhagic stroke. Treatment lowered blood pressure by 5/2 mmHg from day 2 onwards, and was administered for 7 days. At 6 months, activities of daily living were assessed by the Barthel index, and categorized as ‘dependency’ (≤55 points), ‘assisted dependency’ (60–90), or ‘independency’ (≥95). Level of care was categorized as ‘living at own home without public help’, ‘living at home with public help, or in institution for rehabilitation’, or ‘living in institution for long or permanent stay’. We used ordinal and binary logistic regression for statistical analysis, and adjusted for predefined key variables.

Results: Data were available in 1825 patients, of which 1559 (85%) patients had ischaemic and 247 (13%) had haemorrhagic stroke. There were no statistically significant effects of candesartan on the Barthel index or on level of care (adjusted common odds ratio for poor outcome 1.09, 95% confidence interval 0.88–1.35, P = 0.44; and odds ratio 1.05, 95% confidence interval 0.82–1.34, P = 0.69, respectively). In the individual Barthel index domains, there were also no statistically significant differences.

Conclusion: Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months. This result is compatible with the results of the main analysis of the modified Rankin scale, and supports the conclusion that there is no indication for routine blood pressure treatment with candesartan in the acute phase of stroke.