Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events
Why the study?
Does telmisartan 80 mg daily prevent recurrent stroke in patients with recent ischemic stroke?
Population
n=20,332 patients with recent ischemic stroke (median 15 days from stroke to randomization)
Comparison
Telmisartan 80 mg daily initiated early after… vs Placebo
Design
RCT, randomly assigned
Follow-up
mean 2.5 years
Authors
Discussion
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Implication
Does not support early telmisartan for secondary stroke prevention; challenges prior expectations of ARB benefit in acute ischemic stroke.
Key Points
- To assess whether early initiation of the angiotensin-receptor blocker telmisartan reduces recurrent stroke, major cardiovascular events, and new-onset diabetes after an ischemic stroke.
- Multicenter randomized trial (NCT00153062) enrolling 20,332 patients with recent ischemic stroke.
- Participants were randomly assigned at a median of 15 days post-stroke to receive telmisartan 80 mg daily (n=10,146) or placebo (n=10,186) with a mean follow-up of 2.5 years.
- Recurrent stroke occurred in 880 patients (8.7%) in the telmisartan group versus 934 patients (9.2%) in the placebo group (HR 0.95; 95% CI, 0.86 to 1.04; P=0.23).
- Major cardiovascular events occurred in 1,367 patients (13.5%) receiving telmisartan compared with 1,463 patients (14.4%) receiving placebo (HR 0.94; 95% CI, 0.87 to 1.01; P=0.11).
- New-onset diabetes was diagnosed in 1.7% of telmisartan recipients versus 2.1% of placebo recipients (HR 0.82; 95% CI, 0.65 to 1.04; P=0.10), despite a mean blood pressure reduction of 3.8/2.0 mm Hg.
Structured PICO
Does telmisartan 80 mg daily prevent recurrent stroke in patients with recent ischemic stroke?
P
Population
n=20,332 patients with recent ischemic stroke (median 15 days from stroke to randomization)
I
Intervention
Telmisartan 80 mg daily initiated early after stroke and continued for mean 2.5 years
C
Comparator
Placebo
O
Outcome
Recurrent stroke at mean 2.5 years follow-uphard clinical
Initiation of telmisartan early after an ischemic stroke does not significantly reduce the risk of recurrent stroke, major cardiovascular events, or new-onset diabetes.
Cite This Study
Yusuf et al. (2008) studied this question.