WASHINGTON, DC. An international team of researchers from Germany, Hungary, Italy, the Netherlands, Sweden, and the United States reports that the angiotensin II type 1 receptor blocker candesartan (Atacand) is effective in preventing ischemic stroke in older patients with hypertension. Their study involved 1518 elderly patients (average age of 77 years) with isolated systolic hypertension (systolic blood pressure above 160 mm Hg and diastolic pressure below 90 mm Hg). All patients were taking 12.5 mg/day of the diuretic hydrochlorothiazide (HCTZ) at the beginning of the study and continued to do so during the study period. At the beginning of the study, participants were randomized to placebo or 8 mg of candesartan once daily in the morning; the dose of candesartan could be doubled if necessary, and the daily dose of hydrochlorothiazide could also be adjusted as required for adequate blood pressure control.
During the study period of about 3.6 years (5506 person years) blood pressure was reduced by 22/6 mm Hg
in the candesartan group and by 20/5 mm Hg in the placebo group – not a significant difference. The overall
incidence of cardiovascular death, heart attack, and stroke during the study period was slightly lower in the
candesartan group than in the placebo group; however, the difference was not statistically significant. The
incidence of stroke (fatal and non-fatal) was, however, significantly lower in the candesartan group. Here 20
first strokes occurred (7.2/1000 patient-years) as compared to 35 in the placebo group (12.5/1000 patient-
years) – a significant risk reduction of 42%. The researchers conclude that candesartan provides significant
stroke protection in elderly patients with isolated systolic hypertension. They speculate that this beneficial
effect may be due not only to the blood pressure lowering effect of the drug, but perhaps, even more so, to
candesartan's ability to block the angiotensin II type 1 receptor. NOTE: This study was funded by
AstraZeneca, the manufacturer of Atacand.