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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EElevated blood pressure (BP) in the acute phase of stroke has been associated with poor short- and long-term outcomes [Leonard-Bee J et al. \u003Cem\u003EStroke\u003C\/em\u003E 2002]. The Scandinavian Candesartan Acute Stroke Trial [SCAST; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00120003\u0026amp;atom=%2Fspmdc%2F14%2F18%2F11.atom\u0022\u003ENCT00120003\u003C\/a\u003E] did not demonstrate a difference at 6 months between BP lowering with candesartan and placebo for 7 days in the acute phase of stroke (HR, 1.09; 95% CI, 0.84 to 1.41; p=0.52) [Sandset EC et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011]. The aim of this SCAST prespecified secondary analysis was to investigate whether a difference might be observed over longer follow-up.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAmong patients with acute stroke, approximately 75% have systolic blood pressure (BP) \u2265140 mm Hg [Qureshi AI et al. \u003Cem\u003EAm J Emerg Med\u003C\/em\u003E 2007; Leonard-Bee J et al. \u003Cem\u003EStroke\u003C\/em\u003E 2002]. Elevated BP in the acute phase of stroke has been associated with poor short- and long-term outcomes [Leonard-Bee J et al. \u003Cem\u003EStroke\u003C\/em\u003E 2002]. The Phase 2, prospective, randomized Acute Candesartan Cilexetil Therapy in Stroke Survivors study [ACCESS] in 500 patients with stroke found that vascular events and mortality were significantly lowered by candesartan, without a significant difference in adverse event rates [Schrader J et al. \u003Cem\u003EStroke\u003C\/em\u003E 2003]. However, large clinical trials have yet to demonstrate a beneficial effect of BP lowering in the acute phase of stroke.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe Scandinavian Candesartan Acute Stroke Trial [SCAST; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00120003\u0026amp;atom=%2Fspmdc%2F14%2F18%2F11.atom\u0022\u003ENCT00120003\u003C\/a\u003E] did not demonstrate a difference at 6 months between BP lowering with candesartan and placebo for 7 days in the acute phase of stroke (HR, 1.09; 95% CI, 0.84 to 1.41; p=0.52) [Sandset EC et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011]. The aim of this SCAST prespecified secondary analysis, presented by A. G. Hornslien, MD, Oslo University Hospital Ullevaal, Oslo, Norway, was to investigate whether a difference might be observed over longer follow-up.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn total, 2029 patients with acute ischemic or hemorrhagic stroke and systolic BP \u2265140 mm Hg were randomly assigned to candesartan versus placebo for 7 days. Of these patients, long-term follow-up data were available in 632 patients who were allocated to candesartan and 624 patients who were allocated to placebo. Follow-up data were collected from national patient, hospital, and death registries in Norway, Sweden, and Denmark. The primary end point was the composite of stroke, myocardial infarction, or vascular death. The secondary end points were recurrent stroke and all-cause death. Time to first event was analyzed by Cox proportional-hazards regression with adjustment for baseline variables (age, stroke type, systolic BP, and Scandinavian Stroke Scale score).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EBaseline characteristics were well balanced between the 2 arms. At 3 years, there was no significant difference in the primary end point between the candesartan group (28.2%) and the placebo group (32.5%; adjusted HR, 0.87; 95% CI, 0.71 to 1.07; p=0.19).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThere was no significant difference in the recurrent stroke rate between the candesartan group (16.9%) and the placebo group (adjusted HR, 0.83; 95% CI, 0.64 to 1.07; p=0.15) at 3 years. Similarly, no significant difference was observed in the rates of all-cause death in the candesartan group (17.9%) compared with the placebo group (18.8%; adjusted HR, 1.00; 95% CI, 0.77 to 1.30; p=1.00).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EIn this study, candesartan treatment during the acute phase of stroke in patients with elevated BP had no significant effect on the occurrence of vascular events, recurrent stroke, or death at 3 years. These results are consistent with the 6-month results and support the conclusion that there is no indication for routine BP-lowering treatment with candesartan in the acute phase of stroke.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/18\/11.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp12p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}