Effects of Candesartan in Acute Stroke on Cognitive Function and Quality of Life: Results From the Scandinavian Candesartan Acute Stroke Trial

• Published in: Stroke (1970) Vol. 44; no. 7; pp. 2022 - 2024
• Main Authors: Hornslien, Astrid G, Sandset, Else C, Bath, Philip M, Wyller, Torgeir B, Berge, Eivind
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.07.2013; Lippincott Williams & Wilkins
• Subjects: Aged; Aged, 80 and over; Antihypertensive Agents - adverse effects; Antihypertensive Agents - pharmacology; Benzimidazoles - adverse effects; Benzimidazoles - pharmacology; Biological and medical sciences; Cognition Disorders - drug therapy; Cognition Disorders - etiology; Double-Blind Method; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Hypertension - drug therapy; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropsychological Tests; Quality of Life; Scandinavian and Nordic Countries; Stroke - complications; Stroke - drug therapy; Tetrazoles - adverse effects; Tetrazoles - pharmacology; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Scandinavian and Nordic Countries; Hypertension; Imidazole derivatives; Tetrazole derivatives; Stroke; Nervous system diseases; Candesartan; Acute stroke; Peptide hormone; Cardiovascular disease; Cognition; Cerebral disorder; Quality of life; Vascular disease; Octapeptide; Biphenyl derivatives; Central nervous system disease; Antihypertensive agent; Sartan derivatives; Angiotensin antagonist; Angiotensin II; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.113.001022

BACKGROUND AND PURPOSE—High blood pressure is common in the acute phase of stroke and is associated with poor outcome. We examined whether blood pressure–lowering treatment with candesartan in the acute phase affects long-term cognitive function and quality of life. METHODS—Scandinavian Candesartan Acute Stroke Trial was a randomized-controlled and placebo-controlled trial of candesartan in 2029 patients with acute stroke and raised blood pressure. At 6 months, cognitive function was assessed by the Mini Mental State Examination and quality of life by the EuroQol instrument. We used ordinal logistic and multiple linear regression for statistical analysis, adjusting for predefined key variables. RESULTS—Median Mini Mental State Examination score was 28 in both groups, and there was no significant difference between the distribution of Mini Mental State Examination scores in the 2 groups (common odds ratio, 1.11; 95% confidence interval, 0.91–1.34; P=0.32). Median EuroQol-5D index were 0.74 and 0.78 (P=0.034), and the mean EuroQol-visual analogue scale scores were 66.0 and 67.3 in the candesartan and placebo groups, respectively (P=0.11). CONCLUSIONS—Candesartan did not improve cognitive function or quality of life. Rather, there were signs of harmful effects. These findings support the conclusion from our previous report that there is no indication for routine blood pressure–lowering treatment with candesartan in the acute phase of stroke. CLINICAL TRIAL REGISTRATION—URLwww.clinicaltrials.gov. Unique identifierNCT00120003.