Antihypertensives and Statin Therapy for Primary Stroke Prevention: A Secondary Analysis of the HOPE-3 Trial

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Antihypertensives and Statin Therapy for Primary Stroke Prevention : A Secondary Analysis of the HOPE-3 Trial

Bosch, Jackie (author): Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada.;McMaster Univ, Sch Rehabil Sci, Hamilton, ON, Canada.

Lonn, Eva M. (author): Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada.;McMaster Univ, Dept Med, Hamilton, ON, Canada.

Dagenais, Gilles R. (author): Univ Laval, Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada.

Gao, Peggy (author): Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada.

Lopez-Jaramillo, Patricio (author): Univ Santander, Fac Salud, Inst Masira, Bucaramanga, Colombia.

Zhu, Jun (author): Chinese Acad Med Sci & Peking Union Med Coll, Fu Wai Hosp, Beijing, Peoples R China.

Pais, Prem (author): St Johns Res Inst, Bangalore, Karnataka, India.

Avezum, Alvaro (author): Dante Pazzanese Inst Cardiol, Sao Paulo, Brazil.;Univ Sao Paulo, Sao Paulo, Brazil.

Sliwa, Karen (author): Univ Cape Town, Hatter Inst Cardiovasc Res Africa, Dept Med, Soweto Cardiovasc Res Grp, Cape Town, South Africa.

Chazova, Irina E. (author): Natl Med Res Ctr Cardiol, Moscow, Russia.

Peters, Ron J. G. (author): Acad Med Ctr, Dept Cardiol, Amsterdam, Netherlands.

Held, Claes, 1956- (author): Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi

Yusoff, Khalid (author): Univ Teknol Majlis Amansh Rakyat, Selayang, Malaysia.;Univ Coll Sedaya Int Univ, Kuala Lumpur, Malaysia.

Lewis, Basil S. (author): Technion Israel Inst Technol, Ruth & Bruce Rappaport Sch Med, Lady Davis Carmel Med Ctr, Haifa, Israel.

Toff, William D. (author): Univ Leicester, Leicester, Leics, England.;Univ Hosp Leicester NHS Trust, Leicester, Leics, England.

Khunti, Kamlesh (author): Univ Leicester, Leicester Diabet Ctr, Leicester, Leics, England.

Reid, Christopher M. (author): Curtin Univ, Sch Publ Hlth & Prevent Med, Perth, WA, Australia.;Monash Univ, Melbourne, Vic, Australia.

Leiter, Lawrence A. (author): Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Toronto, ON, Canada.;Univ Toronto, Keenan Res Ctr Biomed Sci, St Michaels Hosp, Toronto, ON, Canada.

Yusuf, Salim (author): Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada.;McMaster Univ, Dept Med, Hamilton, ON, Canada.

Hart, Robert G. (author): Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada.;McMaster Univ, Dept Med, Hamilton, ON, Canada.

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Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada;McMaster Univ, Sch Rehabil Sci, Hamilton, ON, Canada. Hamilton Hlth Sci, Populat Hlth Res Inst, Hamilton, ON, Canada.;McMaster Univ, Dept Med, Hamilton, ON, Canada. (creator_code:org_t)

Lippincott Williams & Wilkins, 2021
2021
English.
In: Stroke. - : Lippincott Williams & Wilkins. - 0039-2499 .- 1524-4628. ; 52:8, s. 2494-2501

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

BACKGROUND AND PURPOSE: The HOPE-3 trial (Heart Outcomes Prevention Evaluation-3) found that antihypertensive therapy combined with a statin reduced first stroke among people at intermediate cardiovascular risk. We report secondary analyses of stroke outcomes by stroke subtype, predictors, treatment effects in key subgroups. METHODS: Using a 2-by-2 factorial design, 12705 participants from 21 countries with vascular risk factors but without overt cardiovascular disease were randomized to candesartan 16 mg plus hydrochlorothiazide 12.5 mg daily or placebo and to rosuvastatin 10 mg daily or placebo. The effect of the interventions on stroke subtypes was assessed. RESULTS: Participants were 66 years old and 46% were women. Baseline blood pressure (138/82 mm Hg) was reduced by 6.0/3.0 mm Hg and LDL-C (low-density lipoprotein cholesterol; 3.3 mmol/L) was reduced by 0.90 mmol/L on active treatment. During 5.6 years of follow-up, 169 strokes occurred (117 ischemic, 29 hemorrhagic, 23 undetermined). Blood pressure lowering did not significantly reduce stroke (hazard ratio [H R], 0.80 [95% CI, 0.59-1.08]), ischemic stroke (H R, 0.80 [95% CI, 0.55-1.15]), hemorrhagic stroke (HR, 0.71 [95% CI, 0.34-1.48]), or strokes of undetermined origin (HR, 0.92 [95% CI, 0.41-2.08]). Rosuvastatin significantly reduced strokes (H R, 0.70 [95% CI, 0.52-0.95]), with reductions mainly in ischemic stroke (H R, 0.53 [95% CI, 0.37-0.78]) but did not significantly affect hemorrhagic (H R, 1.22 [95% CI, 0.59-2.54]) or strokes of undetermined origin (H R, 1.29 [95% CI, 0.57-2.95]). The combination of both interventions compared with double placebo substantially and significantly reduced strokes (HR, 0.56 [95% CI, 0.36-0.87]) and ischemic strokes (HR, 0.41 [95% CI, 0.23-0.72]). CONCLUSIONS: Among people at intermediate cardiovascular risk but without overt cardiovascular disease, rosuvastatin 10 mg daily significantly reduced first stroke. Blood pressure lowering combined with rosuvastatin reduced ischemic stroke by 59%. Both therapies are safe and generally well tolerated.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)

Keyword

blood pressure
candesartan
cardiovascular disease
lipoprotein
primary prevention
statin

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ref (subject category)
art (subject category)

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Neurology

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