title: Effects of candesartan in acute stroke on vascular events during long-term follow-up: results from the Scandinavian Candesartan Acute Stroke Trial (SCAST).
abstract: BACKGROUND
  Randomized-controlled trials have shown no beneficial short-term effects of blood pressure lowering treatment in the acute phase of stroke.
  
  
  OBJECTIVE
  We aimed to see whether blood pressure lowering treatment with candesartan in the acute phase can lead to benefits that become apparent over a longer period of follow-up.
  
  
  METHODS
  The Scandinavian Candesartan Acute Stoke Trial was a randomized- and placebo-controlled trial of candesartan in 2,029 patients with acute stroke and systolic blood pressure ≥140 mmHg. Trial treatment was given for seven-days, and the primary follow-up period was six-months. We have used the national patient registries and the cause of death registries in the Scandinavian countries to collect data on vascular events and deaths up to three-years from randomization. The primary end-point was the composite of stroke, myocardial infarction, or vascular death, and we used Cox proportional hazards regression model for analysis.
  
  
  RESULTS
  Long-term data were available for 1,256 of the 1,286 patients (98%) from Scandinavia. The risk of the primary composite end-point did not differ significantly between the groups (candesartan 178/632 events, placebo 203/624 events, hazard ratio = 0·87, 95% confidence interval 0·71-1·07). There were also no statistically significant differences for the secondary end-points stroke and all-cause death, or in any of the pre-specified subgroups.
  
  
  CONCLUSIONS
  Treatment with candesartan in the acute phase of stroke was not associated with clear long-term clinical benefits. This result supports the conclusion from trials with short-term follow-up, that blood pressure lowering treatment with candesartan should not be given routinely to patients with acute stroke and raised blood pressure.
authors: Department of Internal Medicine, Oslo University Hospital, Oslo, Norway.|University of Oslo, Oslo, Norway.
authors: Astrid G
authors: AG
authors: Hornslien
authors: Department of Neurology, Oslo University Hospital, Oslo, Norway.
authors: Else C
authors: EC
authors: Sandset
authors: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors: Jannicke
authors: J
authors: Igland
authors: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors: Andreas
authors: A
authors: Terént
authors: Department of Neurology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Gudrun
authors: G
authors: Boysen
authors: Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
authors: Philip M W
authors: PM
authors: Bath
authors: Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors: Gordon D
authors: GD
authors: Murray
authors: Department of Internal Medicine, Oslo University Hospital, Oslo, Norway.
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 / Q000187:drug effects*; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D016016:Proportional Hazards Models; D012042:Registries; D012306:Risk; D012537:Scandinavian and Nordic Countries; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan
keywords: acute stroke therapy; blood pressure; candesartan; hypertension; long-term results