title: Effects of blood pressure-lowering treatment in different subtypes of acute ischemic stroke.
abstract: OBJECTIVE
  The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of blood pressure-lowering treatment with candesartan in acute stroke. We have investigated whether the effect of treatment is different in different subtypes of ischemic stroke.
  
  
  METHODS
  SCAST was a randomized- and placebo-controlled trial of candesartan in 2029 patients presenting within 30 hours of ischemic or hemorrhagic stroke and systolic blood pressure ≥140 mm Hg. Ischemic stroke subtype was categorized by the Oxfordshire Community Stroke Project classification. There were 2 primary effect variables: the composite vascular end point of vascular death, myocardial infarction, or stroke during the first 6 months and functional outcome at 6 months.
  
  
  RESULTS
  A total of 1733 patients with ischemic stroke were included: total anterior circulation infarcts in 129, partial anterior in 850, posterior in 236, and lacunar in 510 patients. For functional outcome there was a significant trend toward a better effect of candesartan in patients with larger infarcts (total anterior circulation or partial anterior circulation) than in patients with smaller infarcts (lacunar infarction; P=0.02). For the composite vascular end point, there were no differences in treatment effect.
  
  
  CONCLUSIONS
  The results suggest that the effect of blood pressure-lowering treatment with candesartan may differ according to different types of acute ischemic stroke, but this needs to be confirmed in future trials.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00120003.
authors: From the Department of Neurology (E.C.S., M.J.), Department of Haematology (P.M.S.), and Department of Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (P.M.S.); and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.). else@sandset.net.
authors: Else Charlotte
authors: EC
authors: Sandset
authors: From the Department of Neurology (E.C.S., M.J.), Department of Haematology (P.M.S.), and Department of Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (P.M.S.); and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.).
authors: Mirza
authors: M
authors: Jusufovic
authors: From the Department of Neurology (E.C.S., M.J.), Department of Haematology (P.M.S.), and Department of Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (P.M.S.); and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.).
authors: Per Morten
authors: PM
authors: Sandset
authors: From the Department of Neurology (E.C.S., M.J.), Department of Haematology (P.M.S.), and Department of Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (P.M.S.); and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.).
authors: Philip M W
authors: PM
authors: Bath
authors: From the Department of Neurology (E.C.S., M.J.), Department of Haematology (P.M.S.), and Department of Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (P.M.S.); and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.).
authors: Eivind
authors: E
authors: Berge
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure; D002545:Brain Ischemia / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D020300:Intracranial Hemorrhages / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020521:Stroke / Q000188:drug therapy*; D013599:Systole; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan
keywords: angiotension II receptor blocker; blood pressure; candesartan; clinical trial; ischemic stroke