Abstract | BACKGROUND AND PURPOSE:
High blood pressure is one of the main risk factors for cerebral white matter lesions (WMLs). There is limited evidence from one randomized trial that blood pressure-lowering is able to slow WML progression. We investigated whether telmisartan prevents WML progression in the imaging substudy of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS: This predefined substudy comprised 771 patients (mean age, 65 years) with recent ischemic stroke of noncardioembolic origin who received telmisartan or placebo during a mean follow-up of 27.9 (SD, 7.6) months and had 2 evaluable MRI examinations after index stroke and at study closeout. All MRI scans were centrally adjudicated for progression of periventricular and subcortical WML by 2 neuroradiologists blinded to treatment allocation. RESULTS: Mean blood pressure was 3.0/1.3 mm Hg lower with telmisartan compared with placebo at follow-up MRI. There was no statistically significant difference in progression of the mean periventricular WML score (least squares mean difference, 0.14; 95% CI, -0.12 to 0.39; P=0.29) and mean subcortical WML diameter (least squares mean difference, -0.35 mm; 95% CI, -1.00 to 0.31 mm; P=0.30) during follow-up between patients on telmisartan and placebo. CONCLUSIONS: Treatment with telmisartan on top of existing antihypertensive medication did not result in significant blood pressure-lowering and did not prevent the progression of WML in patients with a recent ischemic stroke in this patient cohort. Our analysis is limited by the relatively short follow-up period. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique Identifier: NCT00153062.
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Authors | Ralph Weber, Christian Weimar, Jon Blatchford, Karin Hermansson, Isabel Wanke, Claudia Möller-Hartmann, Elke R Gizewski, Michael Forsting, Andrew M Demchuk, Ralph L Sacco, Jeffrey L Saver, Steven Warach, Hans-Christoph Diener, Anke Diehl, PRoFESS Imaging Substudy Group |
Journal | Stroke
(Stroke)
Vol. 43
Issue 9
Pg. 2336-42
(Sep 2012)
ISSN: 1524-4628 [Electronic] United States |
PMID | 22738922
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Angiotensin II Type 1 Receptor Blockers
- Antihypertensive Agents
- Benzimidazoles
- Benzoates
- Platelet Aggregation Inhibitors
- Aspirin
- Telmisartan
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Topics |
- Age Factors
- Aged
- Aged, 80 and over
- Angiotensin II Type 1 Receptor Blockers
(therapeutic use)
- Antihypertensive Agents
(therapeutic use)
- Aspirin
(therapeutic use)
- Benzimidazoles
(therapeutic use)
- Benzoates
(therapeutic use)
- Blood Pressure
(drug effects, physiology)
- Brain
(pathology)
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Logistic Models
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Platelet Aggregation Inhibitors
(therapeutic use)
- Risk Factors
- Secondary Prevention
- Stroke
(drug therapy, pathology)
- Telmisartan
- Treatment Outcome
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