Nandakumar Nagaraja, MD

Hornslien and colleagues evaluated the data from Scandinavian Candesartan Acute Stroke Trial (SCAST) for the effect of high blood pressure treatment with candesartan in the acute phase of stroke on cognitive function and quality of life. 2029 patients with ischemic and hemorrhagic stroke with SBP ≥ 140mmHg were enrolled into the study within 30hours of onset and they were randomized to candesartan or placebo group for 7 days. Cognitive function was assessed by MMSE and quality of life by EuroQol(EQ) instrument at 6months.
There was no significant difference in the distribution of MMSE scores between the candesartan and placebo group. However, there were small differences with disfavor of candesartan for the five individual EQ-5D domains.
Though this study was not powered to evaluate these outcomes, it suggests that treatment of high blood pressure in the acute phase of stroke is not beneficial for cognitive function or quality of life and rather may be harmful.
Previous studies have shown that long term treatment with perindopril (PROGRESS study) and ramipril (HOPE study) reduce the risk of recurrent stroke. In addition, long term treatment with perindopril resulted in reduced risk of cognitive decline and dementia associated with recurrent stroke. However in the SCAST study, patients were treated with candesartan for short period of 7days in the acute phase of stroke and there was no reduction in recurrent stroke.