No benefit from lowering blood pressure in acute stroke

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Lowering blood pressure in the acute phase of stroke is of no benefit and may be harmful, according to results from SCAST (the Scandinavian Candesartan Acute Stroke Trial).

The trial, published online on February 11th 2011 in The Lancet, showed no improvement on vascular events or functional outcomes at six months with the angiotensin receptor blocker and there was actually a trend toward worse outcomes in the candesartan group.

The authors explain that elevated blood pressure is common in the setting of acute stroke and is associated with poor short- and long-term outcomes. The trial randomised 2,029 patients with acute stroke (either ischaemic or haemorrhagic) and systolic blood pressure above 140 mmHg to receive candesartan or placebo for seven days.

After seven days, blood pressure was significantly lower in the active treatment group, but at six months, the rates of the composite vascular end point in the two groups were not significantly different. The functional outcome results were also less favourable for patients treated with candesartan than for those on placebo.

In an accompanying commentary, Dr Graeme Hankey (Royal Perth Hospital, Australia) says that the results of SCAST, when added to the results of 10 previous trials of blood pressure lowering in acute stroke, increase the reliability of the evidence and suggest that pharmacologically lowering blood pressure does not have a beneficial effect. “Clinicians should therefore not be prescribing blood-pressure-lowering drugs within the first week of acute stroke in routine practice,” he adds.

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