Table 4.
Effect of ACEI/ARB blockade on stroke
| Trial acronym (year of publication) | Population | Patient no. | Comparators | Mean follow-up duration | Major results |
|---|---|---|---|---|---|
| ACEI | |||||
| PROGRESS (2001) PROGRESS Collaborative Group, 2001 | History of stroke or transient ischaemic attack | 6105 | Perindopril (4 mg daily) ± indapamide (2 or 2.5 mg daily) versus placebo | 4.2 years | Perindopril ± indapamide reduced the risk of stroke by 28% (P < 0.0001) and major adverse cardiovascular events by 26% (P < 0.01) |
| HOPE (2000) Yusuf et al., 2000 | High vascular-risk; aged ≥ 55 years | 9297 | Ramipril (10 mg daily) versus placebo | 5.4 years | Ramipril reduced the risk of any stroke by 32% (P < 0.001) |
| ARB | |||||
| ACCESS (2003) Schrader et al., 2003 | Hypertensive; history of ischaemic stroke | 339 | Candesartan (4–16 mg daily) versus placebo | 12 months | Candesartan reduced the risk of mortality by 60% (P = 0.07) and the number of vascular events by 47.6% (P = 0,026) |
| SCOPE (2003) Lithell et al., 2003 | Hypertensive, aged 70–89 years; MMSE score ≥ 24 | 4964 | Candesartan (8–16 mg daily) versus placebo | 3.7 years | Candesartan reduced the risk of non-fatal stroke by 27.8% (P = 0.04) and all stroke by 23.6% (P = 0.056) |
| LIFE (2002) Dahlöf et al., 2002 | Hypertensive; aged 55–80 years; LVH ascertained by electrocardiography | 9193 | Losartan (mean dose 82 mg) versus atenolol (mean dose 79 mg) | 4.8 years | Losartan reduced the risk of fatal or non-fatal stroke by 25% (P = 0.001) |
| MOSES (2005) Schrader et al., 2005 | Hypertensive; high vascular risk; previous stroke | 1405 | Eprosartan (600 mg daily) versus nitrendipine (10 mg daily) | 2.5 years | Eprosartan reduced the risk of combined cardiovascular events by 21% (P = 0.014) and cerebrovascular events by 25% (P = 0.03) |
| PRoFESS (2008) Yusuf et al., 2008a | History of ischaemic stroke | 20 332 | Telmisartan (80 mg daily) versus placebo | 2.5 years | Telmisartan did not significantly lower the rate of stroke (8.7 vs. 9.2%) or major cardiovascular events (13.5 vs. 14.4%) |
| TRANSCEND (2008) Yusuf et al., 2008b | ACEI intolerant; established cardiovascular diseases or diabetes with end-organ damage | 5926 | Telmisartan (80 mg daily) versus placebo | 56 months | Telmisartan did not reduce the risk of stroke (hazard ratio 0.83, P = 0.136) |