Papademetriou V et al. (2004) Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension. J Am Coll Cardiol 44: 1175–1180

Stroke is the major cardiovascular complication of hypertension in older patients. A new study has shown a reduced risk in selected patients receiving candesartan, an angiotensin II type 1 receptor blocker.

In the Study on Cognition and Prognosis in the Elderly (SCOPE), patients were randomly assigned to receive candesartan or placebo, plus open-label antihypertensive therapy as necessary. Since isolated systolic hypertension (ISH) is the predominant form of hypertension in older patients, Papademetriou et al. carried out a predefined subgroup analysis of 1518 patients with ISH (defined as systolic blood pressure ≥160 mmHg and diastolic blood pressure <90 mmHg). Blood-pressure lowering and cardiovascular events were compared between the candesartan and control groups.

After a mean follow-up of 3.6 years, blood pressure reduction was slightly greater (2.0/1.2 mmHg) in patients treated with candesartan (n = 754), than in the control group (n = 764), but this difference was not statistically different. Adjusting for baseline risk, however, there was a 42% relative risk reduction in stroke in the candesartan group (20 vs 35 fatal/nonfatal strokes; P = 0.049).

The authors propose that the observed reduction in stroke risk might have been partly due to the slight improvement in blood pressure control afforded by candesartan treatment. They also suggest that the vascular protective effects of this class of drugs may be responsible for the benefit.