This Article Full Text Full Text (PDF) All Versions of this Article: 34/1/8    most recent 01.STR.0000044950.15362.A4v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fournier, A. Articles by Ersoy, Y. Search for Related Content PubMed PubMed Citation Articles by Fournier, A. Articles by Ersoy, Y.

(Stroke. 2003;34:8.)
© 2003 American Heart Association, Inc.

Letters to the Editor

Converting Enzyme Inhibitor or AT₁-Receptor Blocker for Decreasing Long-Term Mortality in Patients With Stroke History and Renal Dysfunction?

A. Fournier, MD; O. Godefroy, MD; R. Oprisiu, MD; M. Slama, MD M. Andrejak, MD

Department of Nephrology, CHU Hôpital Sud, 80054 Amiens Cedex 1, Paris, France

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

To the Editor:

Having concluded their cohort study with the suggestion that renal dysfunction was an independent risk factor of mortality in patients having had a stroke, MacWalter et al¹ strongly recommend the use of angiotensin-converting enzyme inhibitor (ACEI) to decrease this mortality. They base their recommendation on the HOPE study, in which ramipril comparatively with placebo significantly decreased mortality in both patients with and patients without renal dysfunction,² and on the PROGRESS study. We think, however, that the use of the results of these 2 studies are not entirely appropriate for supporting this exclusive recommendation, alternative recommendation of diuretics and/or AT₁-receptor blockers (ARB) having in our opinion at least equal or even greater evidence basis.

As regards the use of the HOPE trial, we fear that it is not appropriate to extrapolate its results to the kind of population the authors have studied because the baseline characteristics of the 2 studies are quite different regarding the prevalence of coronary heart disease, which was 80% in HOPE and only 15% in their cohort study, whereas the magnitude of stroke history prevalence was the opposite (11% and 100%, respectively). Cardiac death was therefore probably much more prevalent in HOPE (given that heart complication incidence was 5 times higher than that of stroke) than in their cohort study (for which the nature of death is not defined).

As regards the use of PROGRESS trial,³ it is also not quite appropriate despite comparable baseline prevalence of coronary heart disease (CHD) (16% and 15%, respectively) and . . . [Full Text of this Article]

Ronald S. MacWalter, FRCP

Department of Medicine, Ninewells Hospital & Medical School, Dundee, Scotland, UK

Kenneth Y.K. Wong, MRCP; Suzanne Y.S. Wong, MRCP Allan D. Struthers, FRCP

Department of Clinical Pharmacology, Ninewells Hospital & Medical School, Dundee, Scotland, UK

Yuksel Ersoy, MD

Department of Physical Medicine & Rehabilitation, Inonu University Faculty of Medicine, Turgut Ozal Medical Centre, Malatya, Turkey

This article has been cited by other articles:

				J. P. Ruiz, L. M. Medina, F. M. Parra, J. M. de la Higuera Torres-Puchol, R. S. MacWalter, S. Y.S. Wong, K. Y.K. Wong, and A. D. Struthers Stroke Prevention: Indapamide, a Forgotten Option? * Response Stroke, September 1, 2003; 34 (9): e156 - e157. [Full Text] [PDF]