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Telmisartan to prevent recurrent stroke and cardiovascular events

Yusuf, Salim; Diener, Hans-Christoph; Sacco, Ralph L.; Cotton, Daniel; Ounpuu, Stephanie; Lawton, William A.; Palesch, Yuko; Martin, Renée H.; Albers, Gregory W.; Bath, Philip M.W.; Bornstein, Natan; Chan, Bernard P.L.; Chen, Sien-Tsong; Cunha, Luis; Dahlöf, Björn; De Keyser, Jacques; Donnan, Geoffrey A.; Estol, Conrado; Gorelick, Philip; Gu, Vivian; Hermansson, Karin; Hillbrich, Lutz; Kaste, Markku; Lu, Chuanzhen; Machnig, Thomas; Pais, Prem; Roberts, Robin; Skvortsova, Veronika; Teal, Philip; Toni, Danilo; Vandermaelen, Cam; Voight, Thor; Weber, Michael; Yoon, Byung-Woo

Authors

Salim Yusuf

Hans-Christoph Diener

Ralph L. Sacco

Daniel Cotton

Stephanie Ounpuu

William A. Lawton

Yuko Palesch

Renée H. Martin

Gregory W. Albers

Philip M.W. Bath

Natan Bornstein

Bernard P.L. Chan

Sien-Tsong Chen

Luis Cunha

Björn Dahlöf

Jacques De Keyser

Geoffrey A. Donnan

Conrado Estol

Philip Gorelick

Vivian Gu

Karin Hermansson

Lutz Hillbrich

Markku Kaste

Chuanzhen Lu

Thomas Machnig

Prem Pais

Robin Roberts

Veronika Skvortsova

Philip Teal

Danilo Toni

Cam Vandermaelen

Thor Voight

Michael Weber

Byung-Woo Yoon

Abstract

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.)

Journal Article Type Article
Publication Date Aug 27, 2008
Journal New England Journal of Medicine
Print ISSN 0028-4793
Electronic ISSN 0028-4793
Publisher Massachusetts Medical Society
Peer Reviewed Peer Reviewed
Volume 359
Issue 12
Institution Citation Yusuf, S., Diener, H., Sacco, R. L., Cotton, D., Ounpuu, S., Lawton, W. A., …Yoon, B. (2008). Telmisartan to prevent recurrent stroke and cardiovascular events. New England Journal of Medicine, 359(12), doi:10.1056/NEJMoa0804593
DOI https://doi.org/10.1056/NEJMoa0804593
Publisher URL http://content.nejm.org/cgi/content/full/359/12/1225
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf



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