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Title: Telmisartan to prevent recurrent stroke and cardiovascular events
Authors: Yusuf, Salim ×
Diener, Hans-Christoph
Sacco, Ralph L
Cotton, Daniel
Ounpuu, Stephanie
Lawton, William A
Palesch, Yuko
Martin, Reneé H
Albers, Gregory W
Bath, Philip
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
Hilbrich, Lutz
Kaste, Markku
Lu, Chuanzhen
Machnig, Thomas
Pais, Prem
Roberts, Robin
Skvortsova, Veronika
Teal, Philip
Toni, Danilo
VanderMaelen, Cam
Voigt, Thor
Weber, Michael
Yoon, Byung-Woo #
Contributors: Thijs, Vincent
Issue Date: Sep-2008
Series Title: New England Journal of Medicine vol:359 issue:12 pages:1225-1237
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 follow-up 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.)
URI: 
ISSN: 0028-4793
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Research Group Experimental Neurology
Laboratory for Neurobiology (Vesalius Research Center)
× corresponding author
# (joint) last author

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