Telmisartan to prevent recurrent stroke and cardiovascular events.
Telmisartan to prevent recurrent stroke and cardiovascular events.
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DOI：
10.1056/nejmoa0804593
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发表时间：
2008-09-18
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影响因子：
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通讯作者：
PRoFESS Study Group
中科院分区：
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作者：
Yusuf S;Diener HC;Sacco RL;Cotton D;Ounpuu S;Lawton WA;Palesch Y;Martin RH;Albers GW;Bath P;Bornstein N;Chan BP;Chen ST;Cunha L;Dahlöf B;De Keyser J;Donnan GA;Estol C;Gorelick P;Gu V;Hermansson K;Hilbrich L;Kaste M;Lu C;Machnig T;Pais P;Roberts R;Skvortsova V;Teal P;Toni D;VanderMaelen C;Voigt T;Weber M;Yoon BW;PRoFESS Study Group
中风后长期降低血压可降低中风复发的风险。此外，抑制高危患者的肾素-血管紧张素系统可降低后续心血管事件（包括中风）的发生率。然而，中风后不久使用肾素-血管紧张素系统抑制剂降低血压的效果尚未明确。我们评估了中风后早期开始使用血管紧张素受体阻滞剂替米沙坦治疗的效果。在一项涉及 20,332 名最近患有缺血性中风的患者的多中心试验中，我们随机分配 10,146 名患者接受替米沙坦治疗（每天 80 毫克），10,186 名患者接受安慰剂。主要结局是复发性卒中。次要结局是主要心血管事件（心血管原因死亡、复发性中风、心肌梗死或新发或恶化的心力衰竭）和新发糖尿病。从卒中到随机分组的中位间隔为 15 天。在平均 2.5 年的随访期间，替米沙坦组的平均血压比安慰剂组低 3.8/2.0 mm Hg。替米沙坦组共有 880 名患者（8.7%）和安慰剂组有 934 名患者（9.2%）随后发生卒中（替米沙坦组的风险比为 0.95；95% 置信区间 [CI]为 0.86 至 1.04；P = 0.23）。替米沙坦组有 1367 名患者（13.5%）发生主要心血管事件，安慰剂组有 1463 名患者（14.4%）发生主要心血管事件（风险比，0.94；95% CI，0.87 至 1.01；P = 0.11）。替米沙坦组和安慰剂组的新发糖尿病发生率分别为 1.7% 和 2.1%（风险比，0.82；95% CI，0.65 至 1.04；P = 0.10）。缺血性中风后不久开始替米沙坦治疗并持续 2.5 年，并没有显着降低复发性中风、主要心血管事件或糖尿病的发生率。 （ClinicalTrials.gov 编号，NCT00153062。）
Prolonged lowering of blood pressure after a stroke reduces the risk of recurrent stroke. In addition, inhibition of the renin–angiotensin system in high-risk patients reduces the rate of subsequent cardiovascular events, including stroke. However, the effect of lowering of blood pressure with a renin–angiotensin system inhibitor soon after a stroke has not been clearly established. We evaluated the effects of therapy with an angiotensin-receptor blocker, telmisartan, initiated early after a stroke. In a multicenter trial involving 20,332 patients who recently had an ischemic stroke, we randomly assigned 10,146 to receive telmisartan (80 mg daily) and 10,186 to receive placebo. The primary outcome was recurrent stroke. Secondary outcomes were major cardiovascular events (death from cardiovascular causes, recurrent stroke, myocardial infarction, or new or worsening heart failure) and new-onset diabetes. The median interval from stroke to randomization was 15 days. During a mean followup of 2.5 years, the mean blood pressure was 3.8/2.0 mm Hg lower in the telmisartan group than in the placebo group. A total of 880 patients (8.7%) in the telmisartan group and 934 patients (9.2%) in the placebo group had a subsequent stroke (hazard ratio in the telmisartan group, 0.95; 95% confidence interval [CI], 0.86 to 1.04; P = 0.23). Major cardiovascular events occurred in 1367 patients (13.5%) in the telmisartan group and 1463 patients (14.4%) in the placebo group (hazard ratio, 0.94; 95% CI, 0.87 to 1.01; P = 0.11). New-onset diabetes occurred in 1.7% of the telmisartan group and 2.1% of the placebo group (hazard ratio, 0.82; 95% CI, 0.65 to 1.04; P = 0.10). Therapy with telmisartan initiated soon after an ischemic stroke and continued for 2.5 years did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes. (ClinicalTrials.gov number, NCT00153062.)