{"title":"Preventing stroke: the PRoFESS, ONTARGET, and TRANSCEND trial programs.","authors":"Hans-Christoph Diener","doi":"10.1097/01.hjh.0000357906.60778.7f","DOIUrl":null,"url":null,"abstract":"<p><p>Renin-angiotensin system blockers have been shown to reduce stroke risk, partly independent of their blood pressure-lowering effect. The PReventiOn regimen For Effectively avoiding Second Strokes (PRoFESS) trial, ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in aCE-iNtolerant subjects with cardiovascular Disease (TRANSCEND) recently showed potential benefits of the angiotensin II receptor blocker, telmisartan, in reducing secondary strokes. In PRoFESS, 20 332 ischemic stroke patients were randomized to telmisartan 80 mg versus placebo and to two antiplatelets in a 2 x 2 factorial design. After a mean exposure of 2 years, telmisartan showed a nonsignificant lower rate of recurrent stroke versus placebo [880 versus 934; hazard ratio 0.95; 95% confidence interval (CI) 0.86-1.04]. In a post-hoc analysis, from 6 months, telmisartan significantly reduced the number of strokes versus placebo (533 versus 608; hazard ratio 0.88; 95% CI 0.78-0.99; P = 0.042). In the stroke subgroup of ONTARGET, telmisartan 80 mg showed a trend toward reducing recurrent stroke versus ramipril 10 mg (hazard ratio 0.91; 95% CI 0.79-1.05). In the TRANSCEND study, 5926 patients who were intolerant to angiotensin-converting enzyme inhibitors were treated with 80 mg telmisartan or placebo. In a combined analysis of PRoFESS and TRANSCEND, the incidence of the composite of stroke, myocardial infarction, or vascular death was 12.8% for telmisartan versus 13.8% for placebo (hazard ratio 0.91; 95% CI 0.85-0.98; P = 0.013).</p>","PeriodicalId":16074,"journal":{"name":"Journal of hypertension. Supplement : official journal of the International Society of Hypertension","volume":"27 5","pages":"S31-6"},"PeriodicalIF":0.0000,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hjh.0000357906.60778.7f","citationCount":"24","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of hypertension. Supplement : official journal of the International Society of Hypertension","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/01.hjh.0000357906.60778.7f","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 24
Abstract
Renin-angiotensin system blockers have been shown to reduce stroke risk, partly independent of their blood pressure-lowering effect. The PReventiOn regimen For Effectively avoiding Second Strokes (PRoFESS) trial, ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and Telmisartan Randomized AssessmeNt Study in aCE-iNtolerant subjects with cardiovascular Disease (TRANSCEND) recently showed potential benefits of the angiotensin II receptor blocker, telmisartan, in reducing secondary strokes. In PRoFESS, 20 332 ischemic stroke patients were randomized to telmisartan 80 mg versus placebo and to two antiplatelets in a 2 x 2 factorial design. After a mean exposure of 2 years, telmisartan showed a nonsignificant lower rate of recurrent stroke versus placebo [880 versus 934; hazard ratio 0.95; 95% confidence interval (CI) 0.86-1.04]. In a post-hoc analysis, from 6 months, telmisartan significantly reduced the number of strokes versus placebo (533 versus 608; hazard ratio 0.88; 95% CI 0.78-0.99; P = 0.042). In the stroke subgroup of ONTARGET, telmisartan 80 mg showed a trend toward reducing recurrent stroke versus ramipril 10 mg (hazard ratio 0.91; 95% CI 0.79-1.05). In the TRANSCEND study, 5926 patients who were intolerant to angiotensin-converting enzyme inhibitors were treated with 80 mg telmisartan or placebo. In a combined analysis of PRoFESS and TRANSCEND, the incidence of the composite of stroke, myocardial infarction, or vascular death was 12.8% for telmisartan versus 13.8% for placebo (hazard ratio 0.91; 95% CI 0.85-0.98; P = 0.013).
肾素-血管紧张素系统阻滞剂已被证明可以降低中风风险,部分独立于它们的降血压效果。有效避免二次卒中的预防方案(PRoFESS)试验,正在进行的替米沙坦单独和联合雷米普利全球终点试验(ONTARGET)和替米沙坦随机评估研究(TRANSCEND)在ace不耐受的心血管疾病患者中最近显示血管紧张素II受体阻滞剂替米沙坦在减少继发性卒中方面的潜在益处。在PRoFESS中,20332名缺血性卒中患者在2 × 2因子设计中随机接受替米沙坦80mg vs安慰剂和两种抗血小板药物治疗。平均暴露2年后,替米沙坦与安慰剂相比,卒中复发率没有显著降低[880比934;风险比0.95;95%置信区间(CI) 0.86-1.04]。在一项事后分析中,从6个月开始,替米沙坦与安慰剂相比显著减少了中风的数量(533 vs 608;风险比0.88;95% ci 0.78-0.99;P = 0.042)。在ONTARGET的卒中亚组中,替米沙坦80mg与雷米普利10mg相比显示出减少卒中复发的趋势(风险比0.91;95% ci 0.79-1.05)。TRANSCEND研究中,5926例对血管紧张素转换酶抑制剂不耐受的患者接受80mg替米沙坦或安慰剂治疗。在PRoFESS和TRANSCEND的联合分析中,替米沙坦组卒中、心肌梗死或血管性死亡的复合发生率为12.8%,而安慰剂组为13.8%(风险比0.91;95% ci 0.85-0.98;P = 0.013)。