Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events

By S. Yusuf, H. Diener, R. Sacco, Daniel Cotton, S. Ôunpuu, W. A. Lawton, Y. Palesch, Renee' H. Martin, G. Albers, P. Bath and 24 more. New England Journal of Medicine, 2008

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BACKGROUND Prolonged lowering of blood pressure after a stroke reduces the risk of recurrent stroke. In addition, inhibition of the renin–angiotensin system in high-risk patients reduces the rate of subsequent cardiovascular events, including stroke. However, the effect of lowering of blood pressure with a renin–angiotensin system inhibitor soon after a stroke has not been clearly established. We evaluated the effects of therapy with an angiotensin-receptor blocker, telmisartan, initiated early after a stroke. METHODS In a multicenter trial involving 20,332 patients who recently had an ischemic stroke, we randomly assigned 10,146 to receive telmisartan (80 mg daily) and 10,186 to receive placebo. The primary outcome was recurrent stroke. Secondary outcomes were major cardiovascular events (death from cardiovascular causes, recurrent stroke, myocardial infarction, or new or worsening heart failure) and new-onset diabetes. RESULTS The median interval from stroke to randomization was 15 days. During a mean followup of 2.5 years, the mean blood pressure was 3.8/2.0 mm Hg lower in the telmisartan group than in the placebo group. A total of 880 patients (8.7%) in the telmisartan group and 934 patients (9.2%) in the placebo group had a subsequent stroke (hazard ratio in the telmisartan group, 0.95; 95% confidence interval [CI], 0.86 to 1.04; P = 0.23). Major cardiovascular events occurred in 1367 patients (13.5%) in the telmisartan group and 1463 patients (14.4%) in the placebo group (hazard ratio, 0.94; 95% CI, 0.87 to 1.01; P = 0.11). New-onset diabetes occurred in 1.7% of the telmisartan group and 2.1% of the placebo group (hazard ratio, 0.82; 95% CI, 0.65 to 1.04; P = 0.10). CONCLUSIONS Therapy with telmisartan initiated soon after an ischemic stroke and continued for 2.5 years did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes. (ClinicalTrials.gov number, NCT00153062.)

Subfields: Cardiology and Cardiovascular Medicine, Epidemiology

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In Cardiology and Cardiovascular Medicine

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Philippe van de Borne

Citations in the corpus

ESH / ESC Guidelines for the management of arterial hypertension (2013, result): “140 mmHg.(297) Among several trials in patients who had previous coronary events, SBP values lower than 130 mmHg were achieved by more intensive treatment in five trials, but with inconsistent results (a significant reduction of CV events in one,(298) a significant reduction by one antihypertensive ”
The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. (2013, methodology): “2 have mentioned data from three major placebo-controlled RCTs of antihypertensive treatment in patients with a recent (but not acute) stroke or TIA [279,296,297], which provide somewhat conflicting evidence.”
Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part II. (2013, result): “Similarly, in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, telmisartan failed to reduce stroke and major cardiovascular events in diabetic patients with recent stroke when compared with placebo.(114) In contrast, the ACCOMPLISH trial in which 60% of patients had di”
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2018, neutral): “, 2008 (211) 18753639 Aim: To evaluate the effects of therapy with an ARB, telmisartan, initiated early after a stroke”