Treatment with angiotensin-converting enzyme inhibitors is associated with a reduction in short-term mortality in older patients with acute ischemic stroke.
BACKGROUND
Stroke is the third cause of death in older people living in Western countries. We tested the hypothesis that angiotensin-converting enzyme inhibitors (A-I) might affect short-term (30 day) mortality in older persons with severe acute ischemic stroke.


METHODS
We analyzed data from a retrospective study including 475 consecutive older patients hospitalized for acute ischemic stroke. Mean age was 78.4 +/- 9.2 years; 58.2% were female. Stroke type was classified according to the Oxford Community Stroke Project (OCSP).


RESULTS
Mortality rate was 28%. Thirty-two percent of patients were treated with A-I; mortality was 16.5% in patients treated compared with 33.3% in those not treated (chi(2) p =.001). The odds ratio for mortality in treated patients was: 0.47 (0.25-0.89) after full adjustment (age, sex, mean diastolic and systolic blood pressure, previous stroke and/or transient ischemic attack, congestive heart failure, atrial fibrillation, diabetes, hypertension, coronary heart disease, and previous treatment with A-I); 0.29 (0.09-0.89) in patients with altered level of consciousness after full adjustment; 0.60 (0.33-1.12) after adjustment for OCSP classification, age, and sex; and 0.30 (0.08-0.97) in total anterior circulation infarction stroke type after full adjustment.


CONCLUSIONS
Our data suggest that treatment with A-I might reduce short-term mortality in older patients with acute ischemic stroke. Randomized clinical trials should confirm this possible specific effect of A-I.
Zuliani
Giovanni
G
Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology & Geriatrics, University of Ferrara, 44100 Ferrara, Italy. gzuliani@hotmail.com
Cherubini
Antonio
A
Volpato
Stefano
S
Atti
Anna Rita
AR
Blè
Alessandro
A
Vavalle
Chella
C
Di Todaro
Filippo
F
Benedetti
Claudia
C
Ruggiero
Carmelinda
C
Senin
Umberto
U
Fellin
Renato
R
D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D002545:Brain Ischemia / Q000145:classification / Q000188:drug therapy*; D002423:Cause of Death; D002544:Cerebral Infarction / Q000188:drug therapy; D003243:Consciousness / Q000502:physiology; D003327:Coronary Disease / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D020243:Infarction, Anterior Cerebral Artery / Q000188:drug therapy; D020762:Infarction, Posterior Cerebral Artery / Q000188:drug therapy; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000145:classification / Q000188:drug therapy*; D015996:Survival Rate
D000806:Angiotensin-Converting Enzyme Inhibitors