title: Effects of candesartan in acute stroke on activities of daily living and level of care at 6 months.
abstract: OBJECTIVE
  The Scandinavian Candesartan Acute Stroke Trial (SCAST) indicated that blood pressure-lowering treatment with candesartan in the acute phase of stroke has a negative effect on functional outcome at 6 months, measured by the modified Rankin scale. We wanted to see if similar effects can be observed on activities of daily living and level of care.
  
  
  METHODS
  SCAST was an international multicentre, randomized and placebo-controlled trial of candesartan in 2029 patients recruited within 30  h of acute ischaemic or haemorrhagic stroke. Treatment lowered blood pressure by 5/2  mmHg from day 2 onwards, and was administered for 7 days. At 6 months, activities of daily living were assessed by the Barthel index, and categorized as 'dependency' (≤55 points), 'assisted dependency' (60-90), or 'independency' (≥95). Level of care was categorized as 'living at own home without public help', 'living at home with public help, or in institution for rehabilitation', or 'living in institution for long or permanent stay'. We used ordinal and binary logistic regression for statistical analysis, and adjusted for predefined key variables.
  
  
  RESULTS
  Data were available in 1825 patients, of which 1559 (85%) patients had ischaemic and 247 (13%) had haemorrhagic stroke. There were no statistically significant effects of candesartan on the Barthel index or on level of care (adjusted common odds ratio for poor outcome 1.09, 95% confidence interval 0.88-1.35, P = 0.44; and odds ratio 1.05, 95% confidence interval 0.82-1.34, P = 0.69, respectively). In the individual Barthel index domains, there were also no statistically significant differences.
  
  
  CONCLUSIONS
  Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months. This result is compatible with the results of the main analysis of the modified Rankin scale, and supports the conclusion that there is no indication for routine blood pressure treatment with candesartan in the acute phase of stroke.
authors.affiliation: aDepartment of Internal Medicine bDepartment of Neurology cDepartment of Geriatric Medicine, Oslo University Hospital dInstitute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Astrid G
authors.initials: AG
authors.lastname: Hornslien
authors.forename: Else C
authors.initials: EC
authors.lastname: Sandset
authors.forename: Torgeir B
authors.initials: TB
authors.lastname: Wyller
authors.forename: Eivind
authors.initials: E
authors.lastname: Berge
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010919:Placebos; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D010919:Placebos; D013777:Tetrazoles; C081643:candesartan