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N Engl J Med. 2008 Sep 18;359(12):1225-37. doi: 10.1056/NEJMoa0804593. Epub 2008 Aug 27.

Telmisartan to prevent recurrent stroke and cardiovascular events.

Collaborators (1138)

Diener HC, Sacco R, Yusuf S, Blank B, Cotton D, Gu V, Hermansson K, Hilbrich L, Humphreys M, Lawton WA, Machnig T, Ounpuu S, VanderMaelen C, Voigt T, Wu Y, Albers G, Bath P, Bornstein N, Chan B, Chen ST, Cunha L, Dahlöf B, DeKeyser J, Donnan G, Estol C, Gorelick P, Kaste M, Lu C, Pais P, Roberts R, Skvortsova V, Teal P, Toni D, Weber M, Yoon BW, Wolf P, Fisher M, Norrving B, Palesch Y, Sleight P, Turpie A, Buck T, Chong J, Dagenais G, delaPaz R, Diehl A, DiTullio M, Easton D, Ehrenfeld C, Elkind M, Fiebach J, Forsting M, Gizewski E, Gohs D, Halperin J, Haude M, Herz C, Homma S, Kastrup O, Krakauer J, Magun A, Maschke M, Mohr JP, Möller-Hartmann C, Mummel P, Pile-Spellman J, Rodriguez C, Sack S, Schlaak J, Schmermund A, von Kummer R, Wanke I, Weimar C, Wieneke H, Zoepf T, Diener HC, Bath P, Donnan G, Cotton D, Estol C, Hilbrich L, Humphreys M, Ounpuu S, Roberts R, Teal P, Toni D, Sacco R, Yusuf S, Bath P, Sacco R, Cotton D, Dahlöf B, Diener HC, Gorelick P, Roberts R, Weber M, Yusuf S, Hilbrich L, Estol C, Ameriso S, Baumann D, Cirio JJ, Coleman TS, Esnaola y-Rojas MM, Fraiman H, Gabrielli H, Garrote J, Garrote M, Loli P, Ferreiro JL, Lepera S, Pardal M, Rey R, Ruiz A, Saredo G, Simonsini C, Zinnerman A, Donnan G, Bladin C, Crimmins D, Davis S, Frayne J, Hand P, Henderson R, Ingham N, Levi C, Parsons M, Read S, Schultz D, Slattery A, Williams M, Zavala JA, Horner S, Aichner F, Brainin M, Baumhackl U, Brücke T, Doppler W, Dorda V, Haring HP, Seiser A, Wege HW, Wille G, Willeit J, Blecic S, Thijs V, Bruneel B, Caekebeke J, De Klippel N, De Windt A, De Deyn PP, Desfontaines P, Dethy S, Dupuis M, Görner A, Jeangette S, Laloux P, Pandolfo M, Peeters A, Sheorajpanday R, Van Landegem W, Vermylen P, Vanhooren G, Willems C, Massaro AR, André C, Almeida AC, Brondani R, Carvalho JJ, Cendes F, de Freitas GR, Fábio SR, Friedrich MA, Martins M, Martins SC, Maulaz AB, Minelli C, Moro CH, Oliveira-Filho J, Rocha MS, Siqueira-Neto JI, Valiente R, Zétola VH, Teal P, Amir N, Anderson BA, Arts R, Bailey P, Bayer N, Beaudry M, Berger L, Boulanger JM, Brunet D, Collier T, Côté R, Daniels V, Demchuk A, Desai H, Fontaine AM, Gawel M, Gladstone D, Goldstein W, Hachinski V, Herbert F, Hesser K, Hink H, Ho K, Howse D, Kastelic K, Kostyrko P, Lapierre M, Lebrun LH, Mackey A, Maharaj M, Miners L, Minuk J, Moddel G, Mosewich R, Novak D, Penn A, Pesant Y, Pikl P, Rabinovitch A, Rabinovitch H, Sahlas D, Schanz C, Scott J, Selchen D, Sharma M, Shuaib A, Silva J, Silver FL, Spence D, Stefanelli M, Stoger S, Stokes T, Teitelbaum J, Veloso F, Verreault S, Voll C, Walker C, Walker S, Wiegner R, Winder T, Winger M, Woolfenden A, Lu C, Chen DW, Chen HB, Chen SD, Cheng Y, Chi ZF, Cui LY, Di Q, Deng F, Ding MP, Ding SJ, Ding XS, Fan DS, Fan W, Fan XB, Feng HL, Gong J, Gong T, Hong Z, Hou XJ, Hu XQ, Huang YN, Li CY, Li L, Li T, Li W, Li ZY, Lin H, Lin QY, Liu CF, Liu JR, Liu JR, Liu M, Liu R, Liu XF, Liu Y, Luo GG, Luo GQ, Miao JT, Miao L, Pang ZY, Qiu W, Shao B, Sun XJ, Wang DX, Wang F, Wang LJ, Wang SZ, Wang W, Wang YJ, Wu J, Xia J, Xu E, Xu HQ, Xu SB, Xu X, Yang QD, Yi X, Yu PM, Zeng GL, Zeng JS, Zhai Y, Zhang B, Zhang CY, Zhang H, Zhang SH, Zhang WW, Zhang YB, Zhang Y, Zhang Y, Zhao G, Zhao JH, Zhao J, Zhou GX, Zhou HD, Zhao XQ, Zhu GM, Zhu YC, Petersen P, Andersen G, Arlien-Soeborg P, Bach IC, Binzer M, Boysen G, Heick A, Homburg AM, Husted S, Iversen H, Krarup LH, Olsen TS, Overgaard K, Von Weitzel-Mudersbach P, Kaste M, Hillbom M, Koivisto K, Männikkö M, Mustanoja S, Numminen H, Nuutinen J, Sivenius J, Ducrocq X, Leys D, Lucas C, Macian F, Milandre L, Neau JP, Saudeau D, Vespignani H, Voicu M, Zuber M, Busse O, Ahlers A, Allendoerfer J, Benecke R, Boy S, Dethlefs A, Dichgans M, Diener HC, Eicke M, Erbguth F, Gahn G, Gass S, Glahn J, Görtler M, Grau A, Griewing B, Grond M, Grotemeyer KH, Haan J, Hamann G, Harms L, Harscher S, Hetzel A, Hoferichter A, Huelsboemer HB, Ickenstein G, Kaps M, Kirchner M, Kunte H, Liepert J, Malessa R, Mewald Y, Müller-Jensen A, Nabavi D, Nedelmann M, Nueckel M, Poppert H, Rabe K, Regula J, Ringleb P, Rosenkranz M, Schaebitz WR, Schaberger I, Schlachetzki F, Schneider D, Schrader J, Sliwka U, Sobesky J, Soda H, Steinke W, Thomalla HG, Topka H, Treib J, Vry M, Warnecke T, Weber R, Weiller C, Wessel K, Wiethölter H, Witte O, Wuttig H, Iliopoulos I, Ellul I, Giannopoulos S, Karageorgiou C, Papathanasopoulos P, Vassilopoulos D, Voyaki S, Ng PW, Fung BH, Hui KF, Leung T, Mok V, Wong KS, Xavier D, Agarwal A, Agrawal RR, Anandan AM, Anandhi V, Babu GK, Bandishti S, Bhargava A, Bhargava N, Bharani A, Bhatt A, Chidambaram N, Dewan Y, Dinaker M, Joshi R, Joshi S, Kalanidhi A, Kalantri SP, Kothari S, Kumar A, Kumar P, Jain V, Mehndiratta MM, Mijar S, Mishra V, Murali S, Muralidharan RS, Murthy JM, Nair R, Narayanan JT, Panwar RB, Patel P, Poncha F, Prasad VV, Rath A, Reddy BC, Rohatgi A, Roy AK, Sadanandham S, Salam A, Sarma GR, Singh H, Singh Y, Shanmugasundaram S, Sharma S, Sivakumar S, Sundararajan R, Sundararajan T, Tukaram U, Umarani R, Varma S, Velmurugendran CU, Venkitachalam A, Verghese R, Vinayan KP, Vyas A, Wadia RS, Galvin R, Kelly P, O'Mahony D, Bornstein N, Assa-Meirov B, Gross B, Lampl Y, Mahagney A, Merzlyak O, Milo R, Rabey M, Shopin L, Streifler J, Tanne D, Telman G, Turiansky L, Weller B, Yarnitsky D, Provinciali L, Arnaboldi M, Bassi P, Bergamasco B, Carolei A, Cascone G, Chiodo Grandi F, Comi G, Consoli D, Corea F, Dudine P, De Falco FA, Gandolfo C, Giaccaglini E, Gobbi B, Inzitari D, Lembo G, Melis M, Mutani R, Natalé E, Neri G, Rasura M, Sacchetti ML, Semplicini A, Stornello M, Stramba-Badiale M, Sterzi R, Torcasio G, Toso V, Uchiyama S, Yamaguchi T, Chiba K, Fujino Y, Hattori F, Hattori K, Hirai O, Imamura A, Ishii K, Ishihara T, Isobe M, Ito K, Jinnouchi T, Kaido M, Kawamoto T, Kawanishi M, Kim I, Kitazawa K, Kotera M, Kujiraoka Y, Kurokawa S, Maeda Y, Matsumoto K, Matsumoto M, Matsumoto S, Nakagawa F, Nakajima Y, Obata T, Ohnishi H, Sato N, Seguchi T, Seki T, Shibagaki Y, Shitamichi M, Tabuchi A, Takahashi K, Takekawa M, Takimoto Y, Tanabe H, Taniguchi H, Tatsuoka Y, Toda K, Toriyama T, Yamazaki M, Yoshida H, Tan KS, Hassan T, Chong HT, Tan KS, Tharakan JK, Arauz A, Aguayo J, Cantu C, Espinoza C, Fernández-Vera J, Guzman J, León C, Leyva A, López M, López-Ruiz M, Reyes S, Ruiz J, Vazquez R, Villarreal J, De Keyser J, Aramideh M, Boiten J, Brouwers P, de Bruijn B, Franke C, den Heijer J, Dellemijn P, Hagemans J, Keizer K, Kok S, de Kort P, de Kruijk J, Kuipers-Lo Dico J, van Leusden J, van Leusen H, Jansen B, Mulleners WM, ten Napel K, de Rijk-van Andel JF, Van Remmen J, Rutgers W, Schonewille WJ, Simons T, Tacke TJ, Vries E, Wessel J, van Zagten M, Indredavik B, Naess H, Rohweder G, Røsjø Ø, Cunha L, Campillo J, Ferro JM, Lopes G, Pinto AA, Salgado V, Skvortsova V, Alifirova V, Amintaeva A, Antukhova O, Avakyan G, Belkin A, Belova A, Boiko A, Boiko A, Bulgakov V, Cherman M, Dokuchaeva N, Doronin B, Evzelman M, Fedin A, Fedorova N, Gileva O, Glezer M, Golikov K, Halo N, Isakova E, Ivleva A, Kabanova L, Kotov S, Kovalenko A, Kozin G, Lokshtanova T, Lutsky M, Magzhanov R, Martynov M, Mirsaev T, Mulyarov D, Narodova V, Odinak M, Orlov A, Parfenov V, Pizova N, Popova J, Poroshina E, Pronina S, Pryanikova N, Pynchuk E, Renzhina L, Savchenko A, Shirokov E, Shmyrev V, Sholomov I, Shmidt N, Simanenkov V, Skoromets A, Sorokoumov V, Spirin N, Stakhovskaya L, Stepanchenko A, Strachunskaya E, Stulin V, Suslina Z, Timerbaeva S, Trinitatsky Y, Varakin Y, Voskresenskaya O, Yacupov E, Yahno N, Yanishevsky S, Yudina G, Yudelson Y, Zhitkova J, Chan BP, Chang HM, Chen CC, Cheong W, De Silva DA, Gan RN, Meng C, Seah AB, Sharma VK, Soon CS, Venketasubramanian N, Wai Y, Wong MC, Yip CW, Smuts J, Francis P, Gardiner J, Guldenpfennig W, Lurie D, Mochan A, Retief C, Van Niekerk W, Yoon BW, Bang OY, Cho KH, Han SW, Heo JH, Kang DW, Kim HA, Kwon HM, Kwon JH, Kwon SU, Lee BC, Nam HS, Park MS, Rha JH, Yu KH, Gil-Nunez A, Alvarez-Sabín J, Antón C, Egido JA, Gállego J, Gracia F, Moltó JM, Navarro R, Rubio F, Wahlgren NG, Andersson B, von Arbin M, Berglund A, Bertholds E, Bokemark L, Carlstroem C, Elgåsen AC, Eriksson JP, Hansson PO, Käll TB, Lindgren A, Lökk J, Malm J, Markström I, Milovanovic M, Nilsson SA, Persson B, Skogar O, Stenstam M, Teichert J, Karlsson-Tivenius S, Von Euler M, Wallén T, Chen ST, Chang KC, Chang MH, Chang YJ, Chen CH, Chen WH, Chuang YT, Hsu CY, Hu HH, Huang YC, Hwang WJ, Jeng JS, Lee JT, Lien LM, Lin RT, Lin YJ, Liu CH, Peng GS, Po HL, Tan TY, Tsai SC, Wang SF, Wong WJ, Chankrachang S, Chinvarun Y, Chutinet A, Muengtaweepongsa S, Nilanont Y, Poungvarin N, Sithinamsuwan P, Suwanwela N, Tanprawate S, Bahar S, Aktan S, Bakar M, Balkan S, Dalkara T, Kutluk K, Ozdemir G, Moskovko S, Balyskyy O, Bitensky V, Dubenko O, Dzyak L, Goloborodko A, Grebenyuk G, Koselkin A, Kulgeyko V, Kuznetzova S, Lebedynets V, Maly V, Medvedkova S, Melnyk E, Mishchenko T, Moskovko G, Orzheshkovskyy V, Ovsyannikova N, Yavorska V, Yurdanova I, Zushkha V, Bath P, Brawn L, Brown M, Campbell L, Cohen D, Curless R, Davis J, Durward G, Ford G, Gray C, Hammonds FL, Hendra T, James M, Kalra L, Kumar R, Jackson S, Jenkinson D, Lees K, Lip G, MacWalter R, Muir K, Murphy P, Okwera J, Orugun E, Passmore P, Potter J, Sharma A, Sharma J, Sterling M, Ragab S, Robinson T, Roffe C, Rowe A, Turton J, Albers G, Gorelick P, Sacco R, Abbott F, Absher J, Acharya A, Adams H, Akins P, Albakri E, Alberts M, Alonso R, Altafullah I, Anderson E, Andrefsky J, Armstrong R, Arnold G, Arora A, Atkinson R, Azhar S, Bansil S, Becker K, Bell R, Benardo L, Bernardini G, Bernstein A, Blachman P, Boiser J, Boop B, Boutwell C, Bressler D, Brooks C, Brooks W, Calhoun R, Campanella F, Carlson S, Carpenter D, Castaldo J, Castaldo R, Cauli M, Chan K, Chaturvedi S, Cherian S, Chesser M, Chiu D, Clark W, Cleeremans B, Cohen S, Coin T, Collins L, Concha M, Cooper G, Couch J, Coull B, Crisostomo E, Cruz A, Cullis P, Dafer R, Dash S, Davis D, Davis P, DeMatteis J, Diamond B, Dick A, Dietrich D, Dunnigan R, Duong D, Edelsohn L, Ehrenfeld H, Elkins J, Englert M, Erlemeier S, Eubank G, Fayad P, Felberg R, Felton W 3rd, Ferguson R, Flitman S, Fonzetti P, Furie K, Garcia M, Gardziola G, Gebel J, Glass J, Goldstein L, Goldszmidt A, Goli S, Graham G, Graybeal D, Grayum B, Green E, Green J, Green P, Greer D, Gropen T, Gross J, Grotta J, Gunwardane R, Haake B, Habiger T, Halsey J, Hanley D, Hanna J, Hansen C, Hanson S, Harpold G, Harris J, Harris M, Hart R, Hedges K, Hendin B, Hinchey J, Ho J, Hoffman M, Hollander J, Holt W, Holzmacher K, Howell G, Howell S, Huang D, Hughes R, Hull R, Hwang T, Jacobson M, Jacoby M, Jayam-Trouth A, Jackson C, John K, Johnson-Finley B, Johnson M, Johnston S, Kamal A, Karanjia P, Kase C, Kasner S, Katz L, Katz P, Kent T, Kelley R, Kidwell C, Khanna A, Kirshner H, Kleindorfer D, Knox C, Kramer J, Labiche L, Lada R, LaFranchise EF, LaMonte M, Lee M, Lee-Kwen P, Leifer D, Leira E, Levin K, Libman R, Liebeskind D, Lindholm K, Livingstone JN 2nd, Locke G, Logan W, Luciano J, Lutsep H, Majid A, Mangeshkumar V, Markind S, Mate L, McCain J 4th, McElveen WA, McKown B, Merino J, Meyer B, Mikesell T, Mirsen T, Montoya L, Moon S, Moonis M, Moore K, Nasrallah J, Nassief A, Nelson M, Nichols F, Osborne J, Oser F, Ovbiagele B, Palestrant D, Panezai S, Papamitsakis N, Parry G, Perez M, Perkins C, Porter J, Preston W, Rabiee H, Raikhel M, Reichwein R, Remmel K, Richardson B, Ringel R, Rosenbaum D, Ross D, Rubin M, Ruffing K, Sachdev H, Sauter M, Saver J, Schafer J, Schiftan R, Schim J, Schleining AK, Schneck M, Selim M, Sen S, Shafer S, Shafran B, Sharfstein S, Sherman D, Sila C, Silliman S, Silver B, Silverman B, Silverman I, Singh R, Skillings N, Slivka A, Smith D, Soto R, Sparr S, Stephens R, Sullivan H, Sung G, Sutherland J, Syed A, Tabbaa M, Tamulonis D, Taylor R, Tesfaye D, Thomas T, Tietjen G, Todorov A, Torbey M, Tolge B, Tremwell M, Truax W, Unwin D, Vaishnav A, Varma N, Venkatesh YS, Verro P, Verson R, Vidic T, Vrooman P, Wallis R, Wang D, Wang J, Waters M, Wechsler L, Weinberger J, Weissman J, Wheatley G, Whitehead R, Willhite A, Willis H, Wilson E, Wilson R, Wilterdink J, Wirkowski E, Wozniak M, Wright C, Young M, Zachariah S, Zuckerman S, Zweifler R.

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.)

PMID:
18753639
PMCID:
PMC2714258
DOI:
10.1056/NEJMoa0804593
[Indexed for MEDLINE]
Free PMC Article

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