Early blood pressure lowering treatment in acute stroke. Ordinal analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial (SCAST)

Are these earlier research trials now invalidated because of this? Your doctor should know that answer.

Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients

BP Lowering in Acute Stroke Flops for Improving Outcomes 

After stroke, compared with Systolic Blood Pressure in the high range, low to normal SBP is associated with poorer mortality outcomes. 

Systolic Blood Pressure and Mortality After Stroke

Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months

 

 

 

Early blood pressure lowering treatment in acute stroke. Ordinal analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial (SCAST)

Jusufovic, Mirza; Sandset, Else Charlotte; Bath, Philip M.; Berge, Eivind; on behalf of the Scandinavian Candesartan Acute Stroke Trial (SCAST) Study Group

Published Ahead-of-Print

Abstract

Objective: Early blood pressure-lowering treatment appears to be beneficial in patients with acute intracerebral haemorrhage and potentially in ischaemic stroke. We used a new method for analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial to see if the effect was dependent on the timing of treatment.

Methods: Scandinavian Candesartan Acute Stroke Trial was a randomized controlled and placebo-controlled trial of candesartan within 30 h of ischaemic or haemorrhagic stroke. Of 2029 patients, 231 (11.4%) had a vascular event (vascular death, nonfatal stroke or nonfatal myocardial infarction) during the first 6 months. The modified Rankin Scale (mRS) score following a vascular event was used to categorize vascular events in order of severity: no event (n = 1798), minor (mRS 0-2, n = 59), moderately severe (mRS 3-4, n = 57) and major event (mRS 5-6, n = 115). We used ordinal logistic regression for analysis and adjusted for predefined prognostic variables.

Results: Candesartan had no overall effect on vascular events (adjusted common odds ratio 1.11, 95% confidence interval 0.84-1.47, P = 0.48), and the effects were the same in ischaemic and haemorrhagic stroke. Among the patients treated within 6 h, the adjusted common odds ratio for vascular events was 0.37, 95% confidence interval 0.16-0.84, P = 0.02, and there was no heterogeneity of effect between ischaemic and haemorrhagic strokes.

Conclusion: Ordinal analysis of vascular events showed no overall effect of candesartan in the subacute phase of stroke. The effect of treatment given within 6 h of stroke onset appears promising, and will be addressed in ongoing trials. Ordinal analysis of vascular events is feasible and can be used in future trials.