title: Renin-Angiotensin system modulators modestly reduce vascular risk in persons with prior stroke.
abstract: OBJECTIVE
  Although the efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing future vascular events for patients with coronary heart disease is established, less is known about the precise benefit of these agents among patients with stroke. We evaluated whether use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduces future vascular events in persons with prior stroke.
  
  
  METHODS
  We searched PubMed, Cochrane Central Register of Controlled Trials, and bibliographies of relevant trials and recent review articles to identify randomized controlled trials. Relative risk with 95% CI was used as a measure of the association between use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and risks of major vascular event (nonfatal stroke, nonfatal myocardial infarction, or death from cardiovascular causes) or stroke (ischemic or hemorrhagic) after pooling data across trials.
  
  
  RESULTS
  Eight randomized controlled trials with 29 667 participants were identified. Use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in persons with prior stroke was associated with lower risks of future major vascular events (relative risk, 0.91; 95% CI, 0.87-0.97; P=0.001; number needed to treat=71) and recurrent stroke (relative risk, 0.93; 95% CI, 0.86-0.99; P=0.03; number needed to treat=143). Heterogeneity was found among studies for end points of major vascular events (P=0.02, I(2)=61%) but not recurrent stroke (P=0.38, I(2)=6%). In subgroup analyses, there was generally no obvious heterogeneity among different study characteristics.
  
  
  CONCLUSIONS
  Treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker has a clear but rather modest effect on reducing vascular risk in persons with prior stroke.
authors: UCLA Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors: Meng
authors: M
authors: Lee
authors: Jeffrey L
authors: JL
authors: Saver
authors: Keun-Sik
authors: KS
authors: Hong
authors: Qing
authors: Q
authors: Hao
authors: Jessica
authors: J
authors: Chow
authors: Bruce
authors: B
authors: Ovbiagele
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects*; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors