Telmisartan on Top of Antihypertensive Treatment Does Not Prevent Progression of Cerebral White Matter Lesions in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) MRI Substudy
- 1 September 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 43 (9), 2336-2342
- https://doi.org/10.1161/strokeaha.111.648576
Abstract
Background and Purpose—: High blood pressure is one of the main risk factors for cerebral white matter lesions (WMLs). There is limited evidence from one randomized trial that blood pressure-lowering is able to slow WML progression. We investigated whether telmisartan prevents WML progression in the imaging substudy of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. Methods—: This predefined substudy comprised 771 patients (mean age, 65 years) with recent ischemic stroke of noncardioembolic origin who received telmisartan or placebo during a mean follow-up of 27.9 (SD, 7.6) months and had 2 evaluable MRI examinations after index stroke and at study closeout. All MRI scans were centrally adjudicated for progression of periventricular and subcortical WML by 2 neuroradiologists blinded to treatment allocation. Results—: Mean blood pressure was 3.0/1.3 mm Hg lower with telmisartan compared with placebo at follow-up MRI. There was no statistically significant difference in progression of the mean periventricular WML score (least squares mean difference, 0.14; 95% CI, −0.12 to 0.39; P =0.29) and mean subcortical WML diameter (least squares mean difference, −0.35 mm; 95% CI, −1.00 to 0.31 mm; P =0.30) during follow-up between patients on telmisartan and placebo. Conclusions—: Treatment with telmisartan on top of existing antihypertensive medication did not result in significant blood pressure-lowering and did not prevent the progression of WML in patients with a recent ischemic stroke in this patient cohort. Our analysis is limited by the relatively short follow-up period. Clinical Trial Registration—: URL: http://clinicaltrials.gov . Unique Identifier: NCT00153062.Keywords
This publication has 27 references indexed in Scilit:
- Average Daily Blood Pressure, Not Office Blood Pressure, Is Associated With Progression of Cerebrovascular Disease and Cognitive Decline in Older PeopleCirculation, 2011
- Genome‐wide association studies of cerebral white matter lesion burdenAnnals of Neurology, 2011
- Antihypertensive Treatment and Change in Blood Pressure Are Associated With the Progression of White Matter Lesion VolumesCirculation, 2011
- Blood Pressure and White-Matter Disease Progression in a Biethnic CohortStroke, 2010
- Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent StrokeThe New England Journal of Medicine, 2008
- Telmisartan to Prevent Recurrent Stroke and Cardiovascular EventsThe New England Journal of Medicine, 2008
- Progression of White Matter Hyperintensities and Incidence of New Lacunes Over a 3-Year PeriodStroke, 2008
- The Association Between Blood Pressure, Hypertension, and Cerebral White Matter LesionsHypertension, 2004
- Silent Brain Infarcts and White Matter Lesions Increase Stroke Risk in the General PopulationStroke, 2003
- Visual Rating of Age-Related White Matter Changes on Magnetic Resonance ImagingStroke, 2003