Researchers advise against the use of routine blood pressure–lowering treatment in the acute phase of stroke, pending results of other trials that are under way.
LOS ANGELES—Use of the blood pressure–lowering drug candesartan in patients who have high blood pressure in the acute phase of stroke does not provide any benefit, and it may actually be harmful, according to research presented at the 2011 International Stroke Conference. Findings from the Angiotensin-Receptor Blocker Candesartan for Treatment of Acute Stroke (SCAST) study were also published in the February 26 issue of Lancet.
Patients 18 and older with acute stroke and systolic blood pressure above 140 mm Hg received either candesartan (1,017 patients) or placebo (1,012) for seven days. During the treatment period, blood pressure levels were significantly lower in patients given candesartan (147/82 mm Hg), compared with those given placebo (152/84 mm Hg). However, during six months’ follow-up, the risk of vascular death, stroke, or heart attack did not differ significantly between the two groups. Analysis also revealed that patients given candesartan were more likely to have a poor outcome than patients given placebo, although this finding was not statistically significant.
The results were the same in all prespecified subgroups and for all secondary end points. Nine patients in the candesartan group experienced symptoms due to low blood pressure versus five in the placebo group, and kidney failure was also more frequent in the candesartan group (18 patients) than in the placebo group (13 patients).
“Our results showed no beneficial effect of blood pressure–lowering treatment with the angiotensin-receptor blocker candesartan in patients with acute stroke and raised blood pressure,” reported Else Charlotte Sandset, MD, of the Oslo University Hospital Ullevål, Norway, and colleagues. “Other trials are ongoing, but until these trials have been completed, we see no place for routine blood pressure–lowering treatment in the acute phase of stroke.”
In an accompanying comment, Graeme J. Hankey, MD, of the Stroke Unit, Royal Perth Hospital and University of Western Australia, noted, “The results of SCAST, when added to the results of the 10 previous trials of lowering of blood pressure in acute stroke, increase the reliability of the evidence and indicate that, in acute stroke, pharmacologically lowering blood pressure does not have an overall beneficial effect on functional outcome.… Clinicians should therefore not be prescribing blood pressure–lowering drugs within the first week of acute stroke in routine practice.”