Candesartan may cause more harm than good in acute-phase of stroke
MedWire News: Using candesartan to lower the elevated blood pressure (BP) of patients in the acute phase of stroke is not beneficial, researchers suggest.
Instead, "treatment with candesartan was associated with nonsignificant increased risk," say Eivind Berge (Oslo University Hospital Ullevål, Norway) and colleagues.
"Ongoing trials will help to clarify whether this finding is generalizable or whether there are subgroups of patients or different approaches to BP management for which a treatment benefit can be obtained.
"Until these trials have been completed, we see no place for routine BP-lowering treatment in the acute phase of stroke," they comment in The Lancet.
Berge and team recruited 2004 European patients in the acute phase of stroke (less than 30 hours since onset of symptoms). All patients had systolic BP levels of at least 140 mmHg and were randomly allocated to receive candesartan (4mg on day 1, increasing to 16 mg on day 3; n=1000) or placebo (n=1004) for 7 days.
Although lower BP levels were observed among the patients in the candesartan group than the placebo group by day 7 of treatment, at 147/82 versus 152/84 mmHg (p<0.0001), composite 6-month rates of vascular death, myocardial infarction, or stroke, did not differ significantly between the candesartan and placebo groups (120 vs 111).
When functional outcome was assessed using the modified Rankin Scale (in which difficulty in performing daily activities, such as walking, is graded on a scale of 0 to 6), patients in the candesartan group had a 17% higher risk for poor 6-month functional outcome than those in the placebo group. However, this finding was nonsignificant.
In a related commentary, Graeme Hankey from Royal Perth Hospital in West Australia, commented that the findings of Berge et al, "when added to the results of the 10 previous trials of lowering of BP in acute stroke, increase the reliability of the evidence and indicate that...Clinicians should therefore not be prescribing BP-lowering drugs within the first week of acute stroke in routine practice."
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By Lauretta Ihonor