Candesartan for the prevention and treatment of stroke – results of the SCOPE and ACCESS trials

Stroke is a leading cause of death and disability. The SCOPE clinical trial assessed the effects of the angiotensin Type 1 (AT(1))-receptor antagonist, candesartan, on major cardiovascular events in elderly hypertensive patients. A first major cardiovascular event (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) occurred to a lesser extent in the candesartan group (242 of 2477) than the placebo group (268 of 2460) and this difference represented a reduction in stroke rather than cardiac events. The ACCESS trial was designed to assess the safety of a modest blood pressure reduction with the AT 1 -receptor antagonist, candesartan, in the early treatment of stroke. What ACCESS actually showed was that, in the absence of blood pressure lowering, candesartan treatment for 7 days, started within 24 h of motor deficit associated with stoke, reduced the cumulative 12-month mortality rate (7.2 and 2.9% for placebo and candesartan, respectively) and vascular events (18.7 and 9.8% for placebo and candesartan, respectively). In conclusion, candesartan is safe to use in the prevention and treatment of acute stroke, and may provide therapeutic benefits.