OR-38: Access study: acute Candesartan cilexetil evaluation in stroke survivors

Abstract

Objective:

BLD Todays guidelines for antihypertensive therapy in acute ischemic stroke suggest to reduce BP values of over 220 mmHg systolic (AHA) or 200/110 mmHg (german hypertension society). No intervention trials have so far evaluated an immediate BP reduction on the clinical outcome of the pts neurological status (morbidity) or mortality rates in the acute stroke situation. However, some studies show an increase in mortality after a quick BP reduction in a short time interval. The influence of an early, moderate BP reduction with Candesartan cilexetil in patients with acute cerebral ischemia was compared with restrictive antihypertensive therapy in the ACCESS-trial.

Design:

Patients with acute cerebral ischemia and neurological deficit and initial BP values of >200/110 mmHg (systolic and / or diastolic) in occasinal BP measuring or > 180/105 mmHg as median value of two measurements in 30 minutes were randomized. Furthermore a motor paresis had to be present. Patients were treated randomised double-blind for 7 days with placebo or the AT-1-receptor antagonist Candesartan cilexetil. On the 5-7th day all pts got an ABPM.

All hypertensive patients from both groups had been treated with Candesartan if they were hypertensive in the ABPM. Normotensive patients were followed-up, but not treated. If hypertension remained, a combination therapy with other antihypertensive agents was possible. Primary endpoints were the patients morbidity (functional status measured with Rankin and Barthel index, degree of motor deficit by NIH-scale), and mortality rates after 3 months. Follow up was continued for 12 months.

Results:

BLD Inclusion of patients was stopped because of ethical reasons.

Acute Ischemic Stroke, Candesartan Cilexetil, Antihypertensive Treatment in Acute Stroke