Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events
Open accessAbstract
BACKGROUND: 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. METHODS: 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. RESULTS: The median interval from stroke to randomization was 15 days. During a mean follow-up 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). CONCLUSIONS: 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.)
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Syst-Eur provided the most compelling support for dementia prevention by BP lowering.
“The most compelling support for the prevention of dementia by blood pressure lowering was observed in the Systolic Hypertension Europe (Syst-Eur) trial.442,449”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [449]
The Discussion reports findings on recurrent stroke after blood-pressure lowering, but does not discuss dementia prevention or the Syst-Eur trial. Searches for Syst-Eur and dementia in our copy found no passage addressing the claim. (LLM, conf=0.74)
Experimental — accuracy not yet measuredIn Syst-Eur, dementia occurred in 21 placebo and 11 active patients, a 50% (95% CI 0-76) reduction in dementia incidence with active treatment.
“Dementia was diagnosed in 21 patients from the placebo group and 11 patients from the active treatment group, corresponding to a 50% (95% confidence interval 0% to 76%) decrease in the incidence of dementia in subjects receiving active treatment.”
From Vascular Contributions to Cognitive Impairment and Dementia: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (2011) · cites this paper as [449]
The Methods (Study Protocol; page unavailable) describe a telmisartan-versus-placebo trial in patients with recent ischemic stroke, while the Results (Other Outcomes; page unavailable) report outcomes other than dementia. Searches for the stated dementia counts and for Syst-Eur with the 50% reduction found no passage in our copy addressing the claim. (LLM, conf=0.76)
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Capítulo 1 - Conceituação, Epidemiologia e Prevenção Primária
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Self-citation
- Authors
- Yusuf, S., Diener, H.-C., Sacco, R. L., Cotton, D., Ôunpuu, S., Lawton, W. A., Palesch, Y., Martin, R. H., Albers, G. W., Bath, P., Bornstein, N., Chan, B. P. L., Chen, S.-T., Cunha, L., Dahlöf, B., De Keyser, J., Donnan, G. A., 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, B.-W.
- Affiliations
- Population Health Research Institute (CA)
- University of Duisburg-Essen (DE)
- University of Miami (US)
- Boehringer Ingelheim (United States) (US)
- Medical University of South Carolina (US)
- Stanford Medicine (US)
- University of Nottingham (GB)
- Tel Aviv Sourasky Medical Center (IL)
- National University Hospital (SG)
- Chang Gung Memorial Hospital (TW)
- Sahlgrenska University Hospital (SE)
- The University of Melbourne (AU)
- University of Illinois Chicago (US)
- Helsinki University Hospital (FI)
- St.John's Medical College Hospital (IN)
- McMaster University (CA)
- Pirogov Russian National Research Medical University (RU)
- University of British Columbia (CA)
- Sapienza University of Rome (IT)
- SUNY Downstate Health Sciences University (US)
- Seoul National University Hospital (KR)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2008-09-18
- Volume
- 359
- Issue
- 12
- Pages
- 1225-1237
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC2714258
- OpenAlex
- W2111421663
- Cited by
- 785
- References
- 19
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 23 · 2023: 24 · 2022: 24 · 2021: 21 · 2020: 18 · 2019: 27 · 2018: 34 · 2017: 48 · 2016: 45 · 2015: 41 · 2014: 55 · 2013: 47 · 2012: 70
- FWCI
- 65.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- HAL (submittedVersion, other-oa)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
- Nottingham ePrints (University of Nottingham) (submittedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, other-oa)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Gilead Sciences
- Novo Nordisk
- Servier
- National Institutes of Health (5k23ns054084-05)
- Bayer Vital
- National Institute of Neurological Disorders and Stroke (K23-NS054084)
- Daiichi Sankyo Europe
- Cilag
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- telmisartan, ischemic stroke, stroke recurrence, renin-angiotensin system blockade, angiotensin receptor blockers, blood pressure reduction, major cardiovascular events, myocardial infarction, heart failure, new-onset diabetes, secondary stroke prevention, cardiovascular mortality, cardiovascular risk reduction
- MeSH terms
- Telmisartan, Aged, Angiotensin-Converting Enzyme Inhibitors, Benzimidazoles, Benzoates, Blood Pressure, Cardiovascular Diseases, Creatinine, Diabetes Mellitus, Female, Follow-Up Studies, Heart Failure, Humans, Male, Middle Aged, Myocardial Infarction, Potassium, Treatment Failure, Stroke, Kaplan-Meier Estimate, Secondary Prevention
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