Effect of the angiotensin II type 1 receptor antagonist olmesartan on cerebral hemodynamics and rehabilitation outcomes in hypertensive post-stroke patients

PRIMARY OBJECTIVE: In patients with severe hypertension, chronic heart failure or history of stroke, the lower limit of cerebral blood flow (CBF) autoregulation is shifted to a higher blood pressure (BP) than in healthy subjects. This study investigated the effects of the angiotensin II receptor blocker (ARB) olmesartan on human cerebral haemodynamics and rehabilitation outcomes. RESEARCH DESIGN: Open treatment trial with pre-treatment and post-treatment evaluations. EXPERIMENTAL INTERVENTIONS: Olmesartan (10-20 mg) administered daily for 8 weeks. METHODS AND PROCEDURES: The 24-hour BP, clinical BP, CBF at rest, cerebrovascular reserve capacity (CRC) and rehabilitation outcomes (Brunnstrom stage, Barthel index and Mini-Mental State Examination [MMSE] score) were measured in 44 post-stroke patients with hypertension (62.2 +/- 10.7 years). MAIN OUTCOMES AND RESULTS: The systemic BP decreased after treatment compared with baseline. The CBF increased by 11.2% on the affected side and by 8.9% on the non-affected side of the brain and the CRC also increased on both sides. Improvements were observed in the Brunnstrom stage, Barthel index and MMSE score. CONCLUSIONS: This study suggest that olmesartan has beneficial effects in post-stroke patients with hypertension and impaired CBF autoregulation and provides important information necessary to design future more definitive studies.