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(Stroke. 2005;36:1225.)
© 2005 American Heart Association, Inc.

Original Contributions

Editorial Comment: Secondary Prevention of Stroke Is Important

But All Hypertensive Drugs Are Not Created Equal?

Timo E. Strandberg, MD, PhD

Helsinki University Central Hospital, Finland

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The Morbidity and Mortality After Stroke—Eprosartan Compared With Nitrendipine for Secondary Prevention (MOSES) study¹ has 2 important messages. First, it consolidates the evidence that is beneficial to treat hypertension even after a cerebrovascular disorder (stroke or transient ischemic attack) has occurred. Second, and more intriguing, it supports the idea that antihypertensive drugs (specifically angiotensin receptor blocker [ARB] therapy) may have benefits beyond blood pressure lowering.

An overview of hypertension trials including stroke survivors suggested that antihypertensive treatment decreased recurrence of stroke by 28%.² The preliminary result of the Post-Stroke Antihypertensive Treatment Study (PATS) corroborated this finding by showing that indapamide monotherapy with a 5 mm Hg systolic blood pressure reduction lowered the risk of recurrent stroke by 29% compared with placebo.³ The large PROGRESS study further showed that compared with placebo, angiotensin convertase enzyme (ACE) inhibitor–based therapy decreased recurrent cardiovascular complications in stroke survivors.⁴ Interestingly, this effect was not seen in those patients on ACE inhibitor alone, only in those with indapamide and ACE inhibitor combined. This result again strengthened the view that thiazide diuretics may have special effects in stroke prevention.⁵ Now the MOSES study shows that ARB (eprosartan)-based therapy decreased recurrent events compared with calcium channel blocker (nitrendipine)–based therapy among patients with previous cerebrovascular disorders. Because MOSES did not include a placebo group, it is essential that nitrendipine has been tested previously against placebo in the Syst-Eur trial, and there it reduced stroke by 38% and coronary events by 26%.⁶ Consequently, MOSES suggests that with eprosartan, a substantial . . . [Full Text of this Article]

Related Article:

Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention: Principal Results of a Prospective Randomized Controlled Study (MOSES)

Joachim Schrader, Stephan Lüders, Anke Kulschewski, Frank Hammersen, Kerstin Plate, Jürgen Berger, Walter Zidek, Peter Dominiak, Hans Christoph Diener, and the MOSES Study Group
Stroke 2005 36: 1218-1224. [Abstract] [Full Text] [PDF]

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