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Sandset EC, Murray G, Boysen G, Jatuzis D, Kõrv J, Lüders S, Richter PS, Roine RO, Terént A, Thijs V, Berge E. Angiotensin Receptor Blockade in Acute Stroke. the Scandinavian Candesartan Acute Stroke Trial: Rationale, Methods and Design of a Multicentre, Randomised- and Placebo-Controlled Clinical Trial (NCT00120003). Int J Stroke 2010; 5:423-7. [DOI: 10.1111/j.1747-4949.2010.00473.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Elevated blood pressure following acute stroke is common, and yet early antihypertensive treatment is controversial. ACCESS suggested a beneficial effect of the angiotensin receptor blocker candesartan in the acute phase of stroke, but these findings need to be confirmed in new, large trials. Aims and design The Scandinavian Candesartan Acute Stroke Trial is an international randomised, placebo-controlled, double-blind trial of candesartan in acute stroke. We plan to recruit 2500 patients presenting within 30 h of stroke (ischaemic or haemorrhagic) and with systolic blood pressure ≥ 140 mmHg. The recruited patients are randomly assigned to candesartan or placebo for 7-days (doses increasing from 4 to 16mg once daily). Randomisation is performed centrally via a secure web interface. The follow-up period is 6-months. Patients are included from the following nine North-European countries: Norway, Sweden, Denmark, Belgium, Germany, Poland, Lithuania, Estonia and Finland. Study outcomes There are two co-primary effect variables: Funding The Scandinavian Candesartan Acute Stroke Trial receives basic funding from Norwegian health authorities. AstraZeneca supplies the trial drugs, and AstraZeneca and Takeda support the trial with limited, unrestricted grants. Summary The Scandinavian Candesartan Acute Stroke Trial is the first large trial of angiotensin receptor blockers in patients with elevated blood pressure and acute stroke, and aims to answer whether treatment with angiotensin receptor blockers is beneficial for this indication.
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Affiliation(s)
| | - Gordon Murray
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Gudrun Boysen
- Department of Neurology, Bispebjerg Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Dalius Jatuzis
- Faculty of Medicine, Vilnius University and Department of Neurology, Vilnius University Santariskiu Klinikos Hospital, Vilnius, Lithuania
| | - Janika Kõrv
- Department of Neurology, Tartu University Hospital, Tartu, Estonia
| | - Stephan Lüders
- Department of Internal Medicine, St Josefs Hospital, Cloppenburg, Germany
| | | | - Risto O. Roine
- Department of Neurology, Turku University Central Hospital, Turku, Finland
| | - Andreas Terént
- Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Vincent Thijs
- Department of Neurology and Vesalius Research Center (VB), University Hospital Leuven, Leuven, Belgium
| | - Eivind Berge
- Department of Internal Medicine, Oslo University Hospital Ulleval, Oslo, Norway
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Dicker D, Maya I, Vasilevsky V, Gofman M, Markowitz D, Beilin V, Sarid M, Yosefy C. Blood pressure variability in acute ischemic stroke depends on hemispheric stroke location. Blood Press 2006; 15:151-6. [PMID: 16864156 DOI: 10.1080/08037050600772755] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The relationship between blood pressure (BP) variability and stroke location was examined in 85 patients admitted with acute ischemic stroke. The patients were divided into three groups according to stroke location: right hemisphere (32 patients), left hemisphere (30 patients) and non-localized (23 patients). BP upon admission was 147.94/76.53 +/- 20.72/13.70 mmHg in the right hemisphere group, 151.81/76.10 +/- 25.69/16.23 mmHg in the left hemisphere and 155.23/83.41 +/- 30.45/15.74 in the non-localized group. The left hemisphere group had significantly (p < 0.01) greater variations in systolic and diastolic BP between days 2 and 3 and in systolic BP between days 3 and 4 after stroke compared with the other groups. BP in the left hemisphere group was less stable than in the other two groups. Non-localized patients without pre-existing hypertension had a significantly lower and more stable BP during the week following stroke than non-localized patients with pre-existing hypertension. Non-localized patients with pre-existing hypertension had the highest BP and showed no improvement during the week. Systolic BP tended to be higher and less stable in left hemisphere patients than in right hemisphere, whereas among non-localized ischemic stroke patients BP was higher in those who had a prior diagnosis of hypertension.
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Affiliation(s)
- Dror Dicker
- Internal Medicine D, Rabin Medical Center, Campus Hasharon, Israel.
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