Key result
Telmisartan showed potential for a significant later benefit in reducing recurrent stroke compared with placebo in post-6-month data (5.3% vs. 6.0%; HR 0.88; 95% CI 0.78-0.99).
Why the study?
Do ARBs (specifically telmisartan) reduce the risk of primary and secondary stroke compared to ACE inhibitors or placebo?
Do ARBs (specifically telmisartan) reduce the risk of primary and secondary stroke compared to ACE inhibitors or placebo?
Hazard Ratio: 0.88 (95% CI 0.78–0.99)
Absolute Event Rate: 5.3% vs 6%
ARBs, particularly telmisartan, may offer superior stroke prevention compared to ACE inhibitors, with potential delayed benefits in secondary prevention.
Should not yet change ACE inhibitor or ARB prescribing; leaves open class-specific stroke prevention effects in prospective trials.
Treatment of hypertension may represent the most cost-effective strategy for reducing the burden of stroke for patients as well as for healthcare systems. In large clinical trials, angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors have demonstrated potential for preventing both primary and secondary stroke in addition to their blood-pressure-lowering effects. An important question is whether these antihypertensive classes exhibit differential effects on stroke risk. Recently, the ONTARGET study showed that the ARB telmisartan trended towards reduced risk of primary stroke by 9% compared with the ACE inhibitor ramipril. Further evidence of the comparative efficacy of ARBs and ACE inhibitors in the prevention of stroke comes from a meta-analysis of six randomized comparative trials, which showed an 8% difference in primary stroke risk favouring ARBs over ACE inhibitors. Telmisartan may have greater potential to reduce stroke risk than other ARBs because of its highly lipophilic nature, which allows it to cross the blood–brain barrier to inhibit centrally mediated angiotensin II effects. In the PRoFESS study, early telmisartan treatment did not reduce the overall recurrent stroke rate vs. placebo. Analysis of the PRoFESS study post-6-month data showed potential for a significant later benefit with telmisartan compared with placebo (5.3 vs. 6.0%; hazard ratio 0.88; 95% confidence interval 0.78–0.99).
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B. Dahlöf (2009) conducted a review in Stroke. Telmisartan vs. Placebo was evaluated on Recurrent stroke (post-6-month data) (HR 0.88, 95% CI 0.78-0.99). Telmisartan showed potential for a significant later benefit in reducing recurrent stroke compared with placebo in post-6-month data (5.3% vs. 6.0%; HR 0.88; 95% CI 0.78-0.99).
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