Response to Letter by Larsen et al

Schrader, Joachim; Lüders, Stephan; Kulschewski, Anke; Hammersen, F.; Plate, K; Berger, Jean-Pierre; Zidek, Walter; Dominiak, Peter; Diener, Hans Christoph

doi:10.1161/01.str.0000222915.55103.78

Cited by 12 publications

(13 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One trial, Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST; 64% were ischemic stroke patients), was further excluded because a results in patients with ischemic stroke were not reported separately from those with intracranial hemorrhage or stroke-mimicking conditions (Figure 1). 13 Our final analysis included 13 RCTs, [8][9][10][11][14][15][16][17][18][19][20][21] comprising 12 703 individuals, with 6392 (50%) participants randomly assigned to the active treatment group and 6311 (50%) to the control group. The study design, quality, and baseline characteristics of these RCTs are shown in Tables 1 and 2.…”

Section: Resultsmentioning

confidence: 99%

“…Most trials were conducted in Europe, whereas 1 large trial was from China. Analyzed data were abstracted from whole trials that enrolled only patients with ischemic stroke (6 trials), 10,[14][15][16][17]19 separately reported subgroups of patients with ischemic stroke (6 trials), 9,11,18,[20][21][22] and a separately reported subgroup of patients with ischemic stroke enrolled within 72 hours (1 trial). 8 The median time from stroke onset to randomization ranged from 11 to 58 hours.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Blood Pressure Lowering in Early Ischemic Stroke

Lee

Ovbiagele

Hong

et al. 2015

Stroke

108

View full text Add to dashboard Cite

Background and Purpose— Elevated blood pressure is common in acute stage of ischemic stroke and the strategy to manage this situation is not well established. We therefore conducted a meta-analysis of randomized controlled trials comparing active blood pressure lowering and control groups in early ischemic stroke. Methods— Pubmed, EMBASE, and Clinicaltrials.gov from January 1966 to March 2015 were searched to identify relevant studies. We included randomized controlled trials with blood pressure lowering started versus control within 3 days of ischemic stroke onset. The primary outcome was unfavorable outcome at 3 months or at trial end point, defined as dependency or death, and the key secondary outcome was recurrent vascular events. Pooled relative risks and 95% confidence intervals were calculated using random-effects model. Results— The systematic search identified 13 randomized controlled trials with 12 703 participants comparing early blood pressure lowering and control. Pooling the results with the random-effects model showed that blood pressure lowering in early ischemic stroke did not affect the risk of death or dependency at 3 months or at trial end point (relative risk, 1.04; 95% confidence interval, 0.96–1.13; P =0.35). Also, blood pressure lowering also had neutral effect on recurrent vascular events, as well as on disability or death, all-cause mortality, recurrent stroke, and serious adverse events. Conclusions— This meta-analysis suggested blood pressure lowering in early ischemic stroke had a neutral effect on the prevention of death or dependency.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Effect of Blood Pressure Lowering in Early Ischemic Stroke

Lee

Ovbiagele

Hong

et al. 2015

Stroke

108

View full text Add to dashboard Cite

show abstract

“…24,25 Recently, a few preliminary randomized trials of blood pressure reduction in acute ischemic stroke have been published. [26][27][28][29] A phase 2 pilot trial of therapy with the angiotensin receptor blocker candesartan cilexetil was stopped early because of significantly lower mortality and fewer vascular events at 12 months in the treatment group, although blood pressure was similar between the 2 study groups. 26 However, a larger phase 3 trial (SCAST [Scandinavian Candesartan Acute Stroke Trial]) of candesartan therapy enrolling 2029 patients with acute stroke (ischemic or hemorrhagic) showed that the composite vascular end point did not differ between the treatment groups at 6 months, despite a significant difference in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Patients With Acute Ischemic Stroke

Zhang

et al. 2014

JAMA

382

289

View full text Add to dashboard Cite

IMPORTANCE Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain.OBJECTIVE To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge. DESIGN, SETTING, AND PARTICIPANTS The China Antihypertensive Trial in Acute IschemicStroke, a single-blind, blinded end-points randomized clinical trial, conducted among 4071 patients with nonthrombolysed ischemic stroke within 48 hours of onset and elevated systolic blood pressure. Patients were recruited from 26 hospitals across China between August 2009 and May 2013.INTERVENTIONS Patients (n = 2038) were randomly assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10% to 25% within the first 24 hours after randomization, achieving blood pressure less than 140/90 mm Hg within 7 days, and maintaining this level during hospitalization) or to discontinue all antihypertensive medications (control) during hospitalization (n = 2033). MAIN OUTCOMES AND MEASURESPrimary outcome was a combination of death and major disability (modified Rankin Scale score Ն3) at 14 days or hospital discharge.RESULTS Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg (−12.7%) within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg (−7.2%) in the control group within 24 hours after randomization (difference, −5.5% [95% CI, −4.9 to −6.1%]; absolute difference, −9.1 mm Hg [95% CI, −10.2 to −8.1]; P < .001). Mean systolic blood pressure was 137.3 mm Hg in the antihypertensive treatment group and 146.5 mm Hg in the control group at day 7 after randomization (difference, −9.3 mm Hg [95% CI, −10.1 to −8.4]; P < .001). The primary outcome did not differ between treatment groups (683 events [antihypertensive treatment] vs 681 events [control]; odds ratio, 1.00 [95% CI, 0.88 to 1.14]; P = .98) at 14 days or hospital discharge. The secondary composite outcome of death and major disability at 3-month posttreatment follow-up did not differ between treatment groups (500 events [antihypertensive treatment] vs 502 events [control]; odds ratio, 0.99 [95% CI, 0.86 to 1.15]; P = .93).CONCLUSION AND RELEVANCE Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge.

show abstract

“…6,8,9 The study was also based on findings from experimental studies and 1 clinical study indicating that candesartan has beneficial effects in the acute phase of stroke. 10 The absence of any sign of beneficial effects in SCAST might imply that treatment was started too late to limit brain injury, and that blood pressure reduction after the first few hours can only reduce cerebral perfusion and increase brain injury even Data are n (%), mean±SD, or median (interquartile range). ACE indicates angiotensin-converting enzyme; DBP, diastolic blood pressure; mRS, modified Rankin Scale; OCSP, Oxfordshire Community Stroke Project; SBP, systolic blood pressure; SSS, Scandinavian Stroke Scale; and TIA, transient ischemic attack.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure–Lowering Treatment With Candesartan in Patients With Acute Hemorrhagic Stroke

Jusufovic

Sandset

Bath

et al. 2014

Stroke

View full text Add to dashboard Cite

Background and Purpose-Early and intensive blood pressure-lowering treatment seems to be beneficial in patients with acute hemorrhagic stroke and high blood pressure. We wanted to see if similar benefits can be shown from a later and more gradual blood pressure lowering, using data from the Scandinavian Candesartan Acute Stroke Trial (SCAST). Methods-SCAST was a randomized-and placebo-controlled, double-masked trial of candesartan given for 7 days, in 2029 patients with acute stroke and systolic blood pressure ≥140 mm Hg. We assessed the effects of candesartan in the 274 patients with hemorrhagic stroke, using the trial's 2 coprimary effect variables: the composite vascular end point of vascular death, stroke or myocardial infarction, and functional outcome at 6 months, according to the modified Rankin Scale. We used Cox proportional hazards models and ordinal regression for analysis and adjusted for key, predefined prognostic variables. Results-There was no association between treatment with candesartan and risk of vascular events (17 of

show abstract

Response to Letter by Larsen et al

Cited by 12 publications

References 2 publications

Effect of Blood Pressure Lowering in Early Ischemic Stroke

Effect of Blood Pressure Lowering in Early Ischemic Stroke

Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Patients With Acute Ischemic Stroke

Blood Pressure–Lowering Treatment With Candesartan in Patients With Acute Hemorrhagic Stroke

Contact Info

Product

Resources

About