Effects of Candesartan in the Acute Phase of Intracerebral Hemorrhage
| Autor: | Trude Elisabeth Berge, Else Charlotte Sandset, Shoujiang You, Philip M.W. Bath, Craig S. Anderson, Mirza Jusufovic, Eivind Berge, Björn W. Karlson, Rui Guo, Candice Delcourt |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Tetrazoles Blood Pressure Scandinavian and Nordic Countries 03 medical and health sciences 0302 clinical medicine Hematoma Double-Blind Method Internal medicine medicine Humans In patient cardiovascular diseases Stroke Antihypertensive Agents Acute stroke Aged Cerebral Hemorrhage Intracerebral hemorrhage Aged 80 and over business.industry Rehabilitation Biphenyl Compounds Middle Aged medicine.disease nervous system diseases Candesartan Treatment Outcome Cardiology Surgery Benzimidazoles Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Tomography X-Ray Computed Angiotensin II Type 1 Receptor Blockers 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 28(8) |
| ISSN: | 1532-8511 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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