Effect of telmisartan on functional outcome, recurrence, and blood pressure in patients with acute mild ischemic stroke: a PRoFESS subgroup analysis

Bath, Philip M.W.; Martin, Ren�e H.; Palesch, Yuko; Cotton, Daniel; Yusuf, Salim; Sacco, Ralph L.; Diener, Hans-Christoph; Toni, Danilo; Estol, Conrado; Roberts, Robin

Abstract

Background and Purpose: High blood pressure (BP) is common in acute ischemic stroke and associated independently with a poor functional outcome. However, the management of BP acutely remains unclear because no large trials have been completed.
Methods: The factorial PRoFESS secondary stroke prevention trial assessed BP-lowering and antiplatelet strategies in 20 332 patients; 1360 were enrolled within 72 hours of ischemic stroke, with telmisartan (angiotensin receptor antagonist, 80 mg/d, n647) vs placebo (n713). For this nonprespecified subgroup analysis, the primary outcome was functional outcome at 30 days; secondary outcomes included death, recurrence, and hemodynamic measures at up to 90 days. Analyses were adjusted for baseline prognostic variables and antiplatelet assignment.
Results: Patients were representative of the whole trial (age 67 years, male 65%, baseline BP 147/84 mm Hg, small artery disease 60%, NIHSS 3) and baseline variables were similar between treatment groups. The mean time from stroke to recruitment was 58 hours. Combined death or dependency (modified Rankin scale: OR, 1.03; 95% CI, 0.84–1.26; P0.81; death: OR, 1.05; 95% CI, 0.27–4.04; and stroke recurrence: OR, 1.40; 95% CI, 0.68–2.89; P0.36) did not differ between the treatment groups. In comparison with placebo, telmisartan lowered BP (141/82 vs 135/78 mmHg, difference 6 to 7 mmHg and 2 to 4 mmHg; P0.001), pulse pressure (3 to 4 mmHg; P0.002), and rate-pressure product (466 mmHg.bpm; P0.0004).
Conclusion: Treatment with telmisartan in 1360 patients with acute mild ischemic stroke and mildly elevated BP appeared to be safe with no excess in adverse events, was not associated with a significant effect on functional dependency, death, or recurrence, and modestly lowered BP.

Citation

Bath, P. M., Martin, R. H., Palesch, Y., Cotton, D., Yusuf, S., Sacco, R. L., Diener, H.-C., Toni, D., Estol, C., & Roberts, R. (2009). Effect of telmisartan on functional outcome, recurrence, and blood pressure in patients with acute mild ischemic stroke: a PRoFESS subgroup analysis. Stroke, 40(11), 3541-3546. https://doi.org/10.1161/strokeaha.109.555623

• Journal Article Type: Article
• Acceptance Date: Mar 1, 2009
• Online Publication Date: Sep 24, 2009
• Publication Date: Nov 30, 2009
• Deposit Date: Oct 28, 2009
• Journal: Stroke
• Print ISSN: 0039-2499
• Electronic ISSN: 1524-4628
• Publisher: American Heart Association
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Issue: 11
• Pages: 3541-3546
• DOI: https://doi.org/10.1161/strokeaha.109.555623
• Public URL: https://nottingham-repository.worktribe.com/output/1014175
• Publisher URL: https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.109.555623?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed