Effects of Candesartan in the Acute Phase of Intracerebral Hemorrhage.

Abstract

BACKGROUND AND PURPOSE:

Uncertainty persists over the effects of blood pressure-lowering treatment in acute intracerebral hemorrhage (ICH). We assessed the effects of treatment with candesartan in acute ICH and according to different types of hematoma.

METHODS:

Post-hoc analysis of the Scandinavian Candesartan Acute Stroke Trial, a randomized- and placebo-controlled, double-masked trial of candesartan in patients with any stroke within the acute phase (<30 hours) and high systolic blood pressure (≥140 mm Hg). We collected baseline computed tomography scans of participants with ICH, and characterized hematoma volume (planimetric approach), location (deep versus lobar or infratentorial), hemisphere side, and presence of intraventricular hemorrhage. The trial's 2 coprimary effect variables were the composite endpoint of vascular death, stroke or myocardial infarction, and functional outcome at 6 months according to the modified Rankin scale. We used Cox, ordinal, and binary logistic regression for analysis and adjusted for key, predefined prognostic variables.

RESULTS:

Of 274 participants with ICH, computed tomography scans were available in 205 patients (74.8%). There were no significant differences between the candesartan and placebo groups with respect to hematoma volume (median 15.6 mL versus 13.5 mL, P = .96), deep location (77% versus 72%, P = .64), right hemisphere (49% versus 51%, P = .46), and presence of intraventricular hemorrhage (18% versus 11%, P = .22). Candesartan was associated with a significant increase in poor functional outcome in patients with deep hematoma (adjusted common odds ratio 2.27, 95% confidence interval 1.23-4.18, P = .009, P for interaction .015), but there was no differential effect on functional outcome or vascular events in any of the other imaging subgroups.

CONCLUSIONS:

Candesartan was not associated with any beneficial effect when initiated in the acute phase of ICH, a possible adverse effect on functional outcome in patients with deep hematomas cannot be ruled out by this study alone.

• Authors: Mirza Jusufovic, Trude Elisabeth Berge, Rui Guo, Shoujiang You, Candice Delcourt, Craig Anderson, Philip M Bath, Björn W Karlson, Eivind Berge, Else Charlotte Sandset, Scandinavian Candesartan Acute Stroke Trial (SCAST) Study Group
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 28 Issue 8 Pg. 2262-2267 (Aug 2019) ISSN: 1532-8511 [Electronic] United States
• PMID: 31178359 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Antihypertensive Agents
• Benzimidazoles
• Biphenyl Compounds
• Tetrazoles
• candesartan

Topics

• Aged
• Aged, 80 and over
• Angiotensin II Type 1 Receptor Blockers (adverse effects, therapeutic use)
• Antihypertensive Agents (adverse effects, therapeutic use)
• Benzimidazoles (adverse effects, therapeutic use)
• Biphenyl Compounds
• Blood Pressure (drug effects)
• Cerebral Hemorrhage (diagnostic imaging, drug therapy, physiopathology)
• Double-Blind Method
• Female
• Hematoma (diagnostic imaging, drug therapy, physiopathology)
• Humans
• Male
• Middle Aged
• Scandinavian and Nordic Countries
• Tetrazoles (adverse effects, therapeutic use)
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome