Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention

Abstract

Background and Purpose-In hypertensive stroke patients, for the same level of blood pressure control, eprosartan will be more effective than nitrendipine in reducing cerebrovascular and cardiovascular morbidity and mortality. Methods-A total of 1405 well-defined, high-risk hypertensives with cerebral event during the last 24 months (proven by cerebral computed tomography scan or nuclear magnetic resonance) were randomized to eprosartan or nitrendipine (mean follow-up 2.5 years). Primary end point was the composite of total mortality and all cardiovascular and cerebrovascular events, including all recurrent events. Results-Randomization was successful without significant differences in the baseline characteristics. Blood pressure was reduced to a comparable extent without any significant differences between the 2 groups during the whole study period (150.

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

“…1 However, selection of ARBs could provide an additional benefit in stroke reduction for the same degree of blood pressure decrease, as was clearly demonstrated in the LIFE, SCOPE and MOSES studies. [28][29][30][31]35 The results of the VALUE study are in agreement with this hypothesis. The early, higher incidence of stroke in the valsartan treatment group compared to the amlodipine treatment group was due to poor blood pressure control by valsartan.…”

“…The recently published Morbidity and mortality after Stroke, Eprosartan Study (MOSES), provides additional evidence for superior stroke protection by ARBs. 35 This study compared the stroke protective effects of eprosartan vs nitrendipine in poststroke hypertensive patients. After 2.5 years of follow-up, eprosartan decreased the incidence of recurrent stroke by 25% compared to nitrendipine for the same reduction of blood pressure.…”

Effects of high dose olmesartan medoxomil plus hydrochlorothiazide on blood pressure control in patients with grade 2 and grade 3 hypertension

“…4 As a class, ARBs offer various benefits, including a reduced risk of stroke [22][23][24] equivalent efficacy to other antihypertensive agents in reducing the risk of myocardial infarction, 25 and equivalent efficacy to angiotensinconverting enzyme inhibitor-based treatment in reducing CV risk. 26 The placebo-like tolerability profile and low prevalence of new onset diabetes seen with ARBs, 27,28 means that these agents are particularly suitable for combination with thiazide diuretics, and the low level of metabolic abnormalities seen in this study support this.…”

Treatment of hypertension with olmesartan medoxomil, alone and in combination with a diuretic: an update

“…39,51 In other studies, candesartan compared to conventional therapy resulted in 23.4 52 and 40% stroke reduction in the study population and in patients with ISH, respectively. 53,54 In a recent study, eprosartan reduced recurrent strokes by 25% compared to nitrendipine for a similar BP control, in hypertensive patients with a previous stroke. Similar results were also reported from a recent Japanese study, in which high-risk patients treated with a valsartan-based regimen had a 40% lower stroke incidence than patients treated with other drugs for the same BP reduction.…”

“…In addition, ARBs have recently emerged as superior agents for stroke prevention in clinical and experimental studies. 37,[49][50][51][52][53][54][55] In these studies losartan compared to atenolol resulted in a 25 and 40% stroke reduction, in the total study population and in patients with isolated systolic hypertension (ISH) respectively. 39,51 In other studies, candesartan compared to conventional therapy resulted in 23.4 52 and 40% stroke reduction in the study population and in patients with ISH, respectively.…”