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(Stroke. 2003;34:e237.)
© 2003 American Heart Association, Inc.

Letters to the Editor

ACCESS Study:Blood Pressure Effect?

Neurology, Lausanne University Hospital, Lausanne, Switzerland

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

To the Editor:

In order to know whether the apparently striking effects of early treatment with an angiotensin receptor blocker after ischemic stroke¹ were due to the timing of treatment, the drug class, or confounding variables, important information is missing in the article.

We note that blood pressure values were similar in the treatment and the study population, in both the acute and the follow-up period. Furthermore, the curves of cumulative event rates started to diverge only after the phase during which the treatments differed. Explanations for the observed effects may therefore be (1) an influence of candesartan treatment on vascular events following the acute phase, (2) chance, (3) a difference of candesartan doses in the treatment and placebo groups in the follow-up period, where nearly all control patients also received candesartan, or (4) another confounding factor. As the first 2 possibilities are highly unlikely, it is crucial to know the mean dose of candesartan in each group during the follow-up period (beyond 7 days) as it is stated only that there was "no significant difference of concomitant medication ... during follow-up." If the candesartan group received more of this medication during the follow-up period, an important non-antihypertensive effect of candesartan during chronic treatment can be postulated. This possibility is discussed by the authors and suggested by another secondary prevention study showing an advantage in stroke prevention of an angiotensin receptor blocker over a beta-blocker despite similar blood pressure reduction.² If there was no difference of candesartan doses during the . . . [Full Text of this Article]

Walter N. Kernan, MD

Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn

J. Schrader, MD; S. Lüders, MD A. Kulschewski, MD

Department of Internal Medicine, St-Josefs-Hospital, Cloppenburg, Germany

J. Berger, PhD

Institute for Mathematics and Medical Statistics, University Hamburg-Eppendorf, Eppendorf, Germany

W. Zidek, MD

Department of Nephrology, Klinikum-Benjamin Franklin, Freie Universität Berlin, Berlin, Germany

H. C. Diener, MD

Department of Neurology, University of Essen, Essen, Germany

P. Dominiak, MD

Department of Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany