Renin-Angiotensin System Blockade Safely Reduces Blood Pressure in Patients With Minor Ischemic Stroke During the Acute Phase

The ACCESS (Acute Candesartan Cilexetil Therapy in Stroke Survivors) study found that administration of candesartan in the acute phase of stroke confers a long-term benefit in patients who have sustained acute ischemic stroke. This treatment did not significantly reduce blood pressure (BP) during the acute phase, however. We assessed the short-term safety of reducing BP with renin-angiotensin system blockade in hypertensive patients who sustained acute ischemic stroke. Our randomized study compared the effects of 14 days of oral candesartan (4 mg/day), perindopril (4 mg/day), or conventional therapy (topical nitrate only when systolic BP (SBP) was >= 220 mm Hg or diastolic BP (DBP) was >= 120 mm Hg) administered to hypertensive patients within 72 hours of the onset of minor ischemic stroke. We assessed neurologic symptoms using the National Institutes of Health Stroke Scale and the modified Rankin Scale within 72 hours of stroke onset before and after drug therapy. A total of 40 patients completed the protocol. Therapy with candesartan and perindopril reduced SBP/DBP values by 23/11 mm Hg (SBP, P < .01; DBP, P = .07) and 14/0 mm Hg (SBP, P = .07), respectively, compared with conventional treatment. Neurologic symptoms worsened in 2 patients who received perindopril, which has no statistical significance, despite the BP reduction in patients given candesartan or perindopril. Our findings indicate that low doses of candesartan or perindopril safely reduce SBP in hypertensive patients with acute ischemic stroke.