CONCLUSION Despite recent large trials showing no significant effect , in patients that have experienced a TIA or stroke , blood pressure lowering agents reduced the occurrence of subsequent stroke and cardiovascular events .
The rate of myocardial infa rct ion and all-cause mortality was unchanged
BACKGROUND While hypertension is a leading risk factor for an initial stroke , the role of blood pressure lowering to prevent subsequent stroke is less clear .
The results of recent large clinical trials investigating effects of antihypertensive agents in patients with a history of stroke have not shown a significant benefit ; findings that are at odds with previous data .
Our meta- analysis systematic ally evaluates the available , relevant trials to examine the role of antihypertensive drugs in preventing recurrent stroke .
The ACCESS Study: Evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors
Background and Purpose — The Acute C and esartan Cilexetil Therapy in Stroke Survivors ( ACCESS ) study was design ed to assess the safety of modest blood pressure reduction by c and esartan cilexetil in the early treatment of stroke . The study was also design ed to provide an estimate of the number of cases required to perform a larger phase III efficacy study . Methods — Five hundred patients were recruited in a prospect i ve , double-blind , placebo-controlled , r and omized , multicenter phase II study . Results — This safety trial was stopped prematurely when 342 patients ( 339 valid ) had been r and omized because of an imbalance in end points .  Demographic data , cardiovascular risk factors , and blood pressure on admission , on study onset , and within the whole study period were not significantly different between the 2 groups . However , the cumulative 12-month mortality and the number of vascular events differed significantly in favor of the c and esartan cilexetil group ( odds ratio , 0.475 ; 95 % CI , 0.252 to 0.895 ) . There were no significant differences in concomitant medication and in number or type of side effects . Conclusions — Although the mechanisms by which angiotensin type 1 ( AT1 ) receptor blockade affects cardiovascular morbidity and mortality are still unresolved , the present study shows that early neurohumoral inhibition has similar beneficial effects in cerebral and in myocardial ischemia . The fact that no cardiovascular or cerebrovascular event occurred as a result of hypotension is of significant clinical importance . When there is need for or no contraindication against early antihypertensive therapy , c and esartan cilexetil is a safe therapeutic option according to the ACCESS results
CONCLUSION Despite recent large trials showing no significant effect , in patients that have experienced a TIA or stroke , blood pressure lowering agents reduced the occurrence of subsequent stroke and cardiovascular events .
The rate of myocardial infa rct ion and all-cause mortality was unchanged
BACKGROUND While hypertension is a leading risk factor for an initial stroke , the role of blood pressure lowering to prevent subsequent stroke is less clear .
The results of recent large clinical trials investigating effects of antihypertensive agents in patients with a history of stroke have not shown a significant benefit ; findings that are at odds with previous data .
Our meta- analysis systematic ally evaluates the available , relevant trials to examine the role of antihypertensive drugs in preventing recurrent stroke .