Cited by 785Renin-Angiotensin System StudiesBlood Pressure and Hypertension StudiesAcute Ischemic Stroke Management

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Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events

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Yusuf, Salim, Diener, Hans-Christoph, Sacco, Ralph L., Cotton, Daniel, Ôunpuu, Stephanie, Lawton, William A., Palesch, Yuko, Martin, Reneé H., Albers, Gregory W., Bath, Philip, Bornstein, Natan, Chan, Bernard P.L., Chen, Sien-Tsong, Cunha, Luis, Dahlöf, Björn, De Keyser, Jacques, Donnan, Geoffrey A., Estol, Conrado, Gorelick, Philip, Gu, Vivian, Hermansson, Karin, Hilbrich, Lutz, Kaste, Markku, Lu, Chuanzhen, Machnig, Thomas, Pais, Prem, Roberts, Robin, Skvortsova, Veronika, Teal, Philip, Toni, Danilo, VanderMaelen, Cam, Voigt, Thor, Weber, Michael, Yoon, Byung-Woo·2008·New England Journal of Medicine

DOI 10.1056/nejmoa0804593PMC PMC2714258

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Abstract

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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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: Yusuf, Salim
Sacco, Ralph L.
Palesch, Yuko
Albers, Gregory W.
Bath, Philip
Bornstein, Natan
Donnan, Geoffrey A.
Estol, Conrado
Gorelick, Philip
Kaste, Markku
Machnig, Thomas
Pais, Prem
Roberts, Robin
Skvortsova, Veronika
Teal, Philip
Toni, Danilo
Weber, Michael
Yoon, Byung-Woo
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
DOI: 10.1056/nejmoa0804593
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 › Clinical Neurology › 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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Telmisartan to Prevent Recurrent Stroke and Cardiovascular Events

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