Antihypertensives and Statin Therapy for Primary Stroke Prevention: A Secondary Analysis of the HOPE-3 Trial
| Autor: | Irina Chazova, Salim Yusuf, Eva Lonn, Jackie Bosch, Gilles R. Dagenais, Alvaro Avezum, Claes Held, Lawrence A. Leiter, Khalid Yusoff, Robert G. Hart, Prem Pais, Patricio Lopez-Jaramillo, Karen Sliwa, Ron J.G. Peters, Basil S. Lewis, Peggy Gao, Kamlesh Khunti, William D. Toff, Christopher M. Reid, Jun Zhu |
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| Přispěvatelé: | Masira, Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Heart failure & arrhythmias |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Statin medicine.drug_class primary prevention Placebo candesartan Hydrochlorothiazide Double-Blind Method cardiovascular disease Internal medicine medicine Humans Rosuvastatin Lipoprotein Stroke Antihypertensive Agents Aged Advanced and Specialized Nursing Primary prevention Candesartan business.industry lipoprotein Hazard ratio statin blood pressure Middle Aged Cardiovascular disease medicine.disease Blood pressure Cardiology Drug Therapy Combination Female Neurology (clinical) Hydroxymethylglutaryl-CoA Reductase Inhibitors Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
| Zdroj: | Repositorio Universidad de Santander Universidad de Santander instacron:Universidad de Santander Stroke, 52(8), 2494-2501. Lippincott Williams and Wilkins |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Digital Background and Purpose: The HOPE-3 trial (Heart Outcomes Prevention Evaluation–3) found that antihypertensive therapy combined with a statin reduced first stroke among people at intermediate cardiovascular risk. We report secondary analyses of stroke outcomes by stroke subtype, predictors, treatment effects in key subgroups. Methods: Using a 2-by-2 factorial design, 12 705 participants from 21 countries with vascular risk factors but without overt cardiovascular disease were randomized to candesartan 16 mg plus hydrochlorothiazide 12.5 mg daily or placebo and to rosuvastatin 10 mg daily or placebo. The effect of the interventions on stroke subtypes was assessed. Results: Participants were 66 years old and 46% were women. Baseline blood pressure (138/82 mm Hg) was reduced by 6.0/3.0 mm Hg and LDL-C (low-density lipoprotein cholesterol; 3.3 mmol/L) was reduced by 0.90 mmol/L on active treatment. During 5.6 years of follow-up, 169 strokes occurred (117 ischemic, 29 hemorrhagic, 23 undetermined). Blood pressure lowering did not significantly reduce stroke (hazard ratio [HR], 0.80 [95% CI, 0.59–1.08]), ischemic stroke (HR, 0.80 [95% CI, 0.55–1.15]), hemorrhagic stroke (HR, 0.71 [95% CI, 0.34–1.48]), or strokes of undetermined origin (HR, 0.92 [95% CI, 0.41–2.08]). Rosuvastatin significantly reduced strokes (HR, 0.70 [95% CI, 0.52–0.95]), with reductions mainly in ischemic stroke (HR, 0.53 [95% CI, 0.37–0.78]) but did not significantly affect hemorrhagic (HR, 1.22 [95% CI, 0.59–2.54]) or strokes of undetermined origin (HR, 1.29 [95% CI, 0.57–2.95]). The combination of both interventions compared with double placebo substantially and significantly reduced strokes (HR, 0.56 [95% CI, 0.36–0.87]) and ischemic strokes (HR, 0.41 [95% CI, 0.23–0.72]). Conclusions: Among people at intermediate cardiovascular risk but without overt cardiovascular disease, rosuvastatin 10 mg daily significantly reduced first stroke. Blood pressure lowering combined with rosuvastatin reduced ischemic stroke by 59%. Both therapies are safe and generally well tolerated. Correction to: Antihypertensives and Statin Therapy for Primary Stroke Prevention: A Secondary Analysis of the HOPE-3 Trial Ciencias Médicas y de la Salud |
| Databáze: | OpenAIRE |
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