title: Early blood pressure lowering treatment in acute stroke. Ordinal analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial (SCAST).
abstract: Early blood pressure-lowering treatment appears to be beneficial in patients with acute intracerebral haemorrhage and potentially in ischaemic stroke. We used a new method for analysis of vascular events in the Scandinavian Candesartan Acute Stroke Trial to see if the effect was dependent on the timing of treatment.
  
  
  
  Scandinavian Candesartan Acute Stroke Trial was a randomized controlled and placebo-controlled trial of candesartan within 30 h of ischaemic or haemorrhagic stroke. Of 2029 patients, 231 (11.4%) had a vascular event (vascular death, nonfatal stroke or nonfatal myocardial infarction) during the first 6 months. The modified Rankin Scale (mRS) score following a vascular event was used to categorize vascular events in order of severity: no event (n = 1798), minor (mRS 0-2, n = 59), moderately severe (mRS 3-4, n = 57) and major event (mRS 5-6, n = 115). We used ordinal logistic regression for analysis and adjusted for predefined prognostic variables.
  
  
  
  Candesartan had no overall effect on vascular events (adjusted common odds ratio 1.11, 95% confidence interval 0.84-1.47, P = 0.48), and the effects were the same in ischaemic and haemorrhagic stroke. Among the patients treated within 6 h, the adjusted common odds ratio for vascular events was 0.37, 95% confidence interval 0.16-0.84, P = 0.02, and there was no heterogeneity of effect between ischaemic and haemorrhagic strokes.
  
  
  
  Ordinal analysis of vascular events showed no overall effect of candesartan in the subacute phase of stroke. The effect of treatment given within 6 h of stroke onset appears promising, and will be addressed in ongoing trials. Ordinal analysis of vascular events is feasible and can be used in future trials.
authors.affiliation: aDept. of Neurology, Oslo University Hospital, Oslo, Norway bStroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK cDept. of Internal Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Mirza
authors.initials: M
authors.lastname: Jusufovic
authors.forename: Else Charlotte
authors.initials: EC
authors.lastname: Sandset
authors.forename: Philip M
authors.initials: PM
authors.lastname: Bath
authors.forename: Eivind
authors.initials: E
authors.lastname: Berge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D001794:Blood Pressure / Q000187:drug effects*; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000188:drug therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology*; D016017:Odds Ratio; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan