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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, Renée H.; Palesch, Yuko; Cotton, Daniel; Yusuf, Salim; Sacco, Ralph L.; Diener, Hans-Christoph; Toni, Danilo; Estol, Conrado; Roberts, Robin


Philip M.W. Bath

Renée H. Martin

Yuko Palesch

Daniel Cotton

Salim Yusuf

Ralph L. Sacco

Hans-Christoph Diener

Danilo Toni

Conrado Estol

Robin Roberts


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.

Journal Article Type Article
Publication Date Nov 30, 2009
Journal Stroke
Print ISSN 0039-2499
Electronic ISSN 0039-2499
Publisher American Heart Association
Peer Reviewed Peer Reviewed
Volume 40
Issue 11
Pages 3541-3546
APA6 Citation Bath, P. M., Martin, R. H., Palesch, Y., Cotton, D., Yusuf, S., Sacco, R. L., …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. doi:10.1161/strokeaha.109.555623
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