Telmisartan on top of antihypertensive treatment does not prevent progression of cerebral white matter lesions in the prevention regimen for effectively avoiding second strokes (PRoFESS) MRI substudy

Ralph Weber, Christian Weimar, Jon Blatchford, Karin Hermansson, Isabel Wanke, Claudia Möller-Hartmann, Elke R. Gizewski, Michael Forsting, Andrew M. Demchuk, Ralph L. Sacco, Jeffrey L. Saver, Steven Warach, Hans Christoph Diener, Anke Diehl

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND PURPOSE-: High blood pressure is one of the main risk factors for cerebral white matter lesions (WMLs). There is limited evidence from one randomized trial that blood pressure-lowering is able to slow WML progression. We investigated whether telmisartan prevents WML progression in the imaging substudy of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS-: This predefined substudy comprised 771 patients (mean age, 65 years) with recent ischemic stroke of noncardioembolic origin who received telmisartan or placebo during a mean follow-up of 27.9 (SD, 7.6) months and had 2 evaluable MRI examinations after index stroke and at study closeout. All MRI scans were centrally adjudicated for progression of periventricular and subcortical WML by 2 neuroradiologists blinded to treatment allocation. RESULTS-: Mean blood pressure was 3.0/1.3 mm Hg lower with telmisartan compared with placebo at follow-up MRI. There was no statistically significant difference in progression of the mean periventricular WML score (least squares mean difference, 0.14; 95% CI, -0.12 to 0.39; P=0.29) and mean subcortical WML diameter (least squares mean difference, -0.35 mm; 95% CI, -1.00 to 0.31 mm; P=0.30) during follow-up between patients on telmisartan and placebo. CONCLUSIONS-: Treatment with telmisartan on top of existing antihypertensive medication did not result in significant blood pressure-lowering and did not prevent the progression of WML in patients with a recent ischemic stroke in this patient cohort. Our analysis is limited by the relatively short follow-up period. CLINICAL TRIAL REGISTRATION-: URL: http://clinicaltrials.gov. Unique Identifier: NCT00153062.

Original languageEnglish (US)
Pages (from-to)2336-2342
Number of pages7
JournalStroke
Volume43
Issue number9
DOIs
StatePublished - Sep 2012

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Antihypertensive Agents
Stroke
Placebos
Blood Pressure
Least-Squares Analysis
Therapeutics
telmisartan
White Matter
Magnetic Resonance Imaging
Clinical Trials
Hypertension

Keywords

  • antihypertensive treatment
  • cerebral small vessel disease
  • ischemic stroke
  • magnetic resonance imaging
  • secondary prevention
  • telmisartan
  • white matter lesion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Telmisartan on top of antihypertensive treatment does not prevent progression of cerebral white matter lesions in the prevention regimen for effectively avoiding second strokes (PRoFESS) MRI substudy. / Weber, Ralph; Weimar, Christian; Blatchford, Jon; Hermansson, Karin; Wanke, Isabel; Möller-Hartmann, Claudia; Gizewski, Elke R.; Forsting, Michael; Demchuk, Andrew M.; Sacco, Ralph L.; Saver, Jeffrey L.; Warach, Steven; Diener, Hans Christoph; Diehl, Anke.

In: Stroke, Vol. 43, No. 9, 09.2012, p. 2336-2342.

Research output: Contribution to journalArticle

Weber, R, Weimar, C, Blatchford, J, Hermansson, K, Wanke, I, Möller-Hartmann, C, Gizewski, ER, Forsting, M, Demchuk, AM, Sacco, RL, Saver, JL, Warach, S, Diener, HC & Diehl, A 2012, 'Telmisartan on top of antihypertensive treatment does not prevent progression of cerebral white matter lesions in the prevention regimen for effectively avoiding second strokes (PRoFESS) MRI substudy', Stroke, vol. 43, no. 9, pp. 2336-2342. https://doi.org/10.1161/STROKEAHA.111.648576
Weber, Ralph ; Weimar, Christian ; Blatchford, Jon ; Hermansson, Karin ; Wanke, Isabel ; Möller-Hartmann, Claudia ; Gizewski, Elke R. ; Forsting, Michael ; Demchuk, Andrew M. ; Sacco, Ralph L. ; Saver, Jeffrey L. ; Warach, Steven ; Diener, Hans Christoph ; Diehl, Anke. / Telmisartan on top of antihypertensive treatment does not prevent progression of cerebral white matter lesions in the prevention regimen for effectively avoiding second strokes (PRoFESS) MRI substudy. In: Stroke. 2012 ; Vol. 43, No. 9. pp. 2336-2342.
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abstract = "BACKGROUND AND PURPOSE-: High blood pressure is one of the main risk factors for cerebral white matter lesions (WMLs). There is limited evidence from one randomized trial that blood pressure-lowering is able to slow WML progression. We investigated whether telmisartan prevents WML progression in the imaging substudy of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS-: This predefined substudy comprised 771 patients (mean age, 65 years) with recent ischemic stroke of noncardioembolic origin who received telmisartan or placebo during a mean follow-up of 27.9 (SD, 7.6) months and had 2 evaluable MRI examinations after index stroke and at study closeout. All MRI scans were centrally adjudicated for progression of periventricular and subcortical WML by 2 neuroradiologists blinded to treatment allocation. RESULTS-: Mean blood pressure was 3.0/1.3 mm Hg lower with telmisartan compared with placebo at follow-up MRI. There was no statistically significant difference in progression of the mean periventricular WML score (least squares mean difference, 0.14; 95{\%} CI, -0.12 to 0.39; P=0.29) and mean subcortical WML diameter (least squares mean difference, -0.35 mm; 95{\%} CI, -1.00 to 0.31 mm; P=0.30) during follow-up between patients on telmisartan and placebo. CONCLUSIONS-: Treatment with telmisartan on top of existing antihypertensive medication did not result in significant blood pressure-lowering and did not prevent the progression of WML in patients with a recent ischemic stroke in this patient cohort. Our analysis is limited by the relatively short follow-up period. CLINICAL TRIAL REGISTRATION-: URL: http://clinicaltrials.gov. Unique Identifier: NCT00153062.",
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T1 - Telmisartan on top of antihypertensive treatment does not prevent progression of cerebral white matter lesions in the prevention regimen for effectively avoiding second strokes (PRoFESS) MRI substudy

AU - Weber, Ralph

AU - Weimar, Christian

AU - Blatchford, Jon

AU - Hermansson, Karin

AU - Wanke, Isabel

AU - Möller-Hartmann, Claudia

AU - Gizewski, Elke R.

AU - Forsting, Michael

AU - Demchuk, Andrew M.

AU - Sacco, Ralph L.

AU - Saver, Jeffrey L.

AU - Warach, Steven

AU - Diener, Hans Christoph

AU - Diehl, Anke

PY - 2012/9

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N2 - BACKGROUND AND PURPOSE-: High blood pressure is one of the main risk factors for cerebral white matter lesions (WMLs). There is limited evidence from one randomized trial that blood pressure-lowering is able to slow WML progression. We investigated whether telmisartan prevents WML progression in the imaging substudy of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS-: This predefined substudy comprised 771 patients (mean age, 65 years) with recent ischemic stroke of noncardioembolic origin who received telmisartan or placebo during a mean follow-up of 27.9 (SD, 7.6) months and had 2 evaluable MRI examinations after index stroke and at study closeout. All MRI scans were centrally adjudicated for progression of periventricular and subcortical WML by 2 neuroradiologists blinded to treatment allocation. RESULTS-: Mean blood pressure was 3.0/1.3 mm Hg lower with telmisartan compared with placebo at follow-up MRI. There was no statistically significant difference in progression of the mean periventricular WML score (least squares mean difference, 0.14; 95% CI, -0.12 to 0.39; P=0.29) and mean subcortical WML diameter (least squares mean difference, -0.35 mm; 95% CI, -1.00 to 0.31 mm; P=0.30) during follow-up between patients on telmisartan and placebo. CONCLUSIONS-: Treatment with telmisartan on top of existing antihypertensive medication did not result in significant blood pressure-lowering and did not prevent the progression of WML in patients with a recent ischemic stroke in this patient cohort. Our analysis is limited by the relatively short follow-up period. CLINICAL TRIAL REGISTRATION-: URL: http://clinicaltrials.gov. Unique Identifier: NCT00153062.

AB - BACKGROUND AND PURPOSE-: High blood pressure is one of the main risk factors for cerebral white matter lesions (WMLs). There is limited evidence from one randomized trial that blood pressure-lowering is able to slow WML progression. We investigated whether telmisartan prevents WML progression in the imaging substudy of the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS-: This predefined substudy comprised 771 patients (mean age, 65 years) with recent ischemic stroke of noncardioembolic origin who received telmisartan or placebo during a mean follow-up of 27.9 (SD, 7.6) months and had 2 evaluable MRI examinations after index stroke and at study closeout. All MRI scans were centrally adjudicated for progression of periventricular and subcortical WML by 2 neuroradiologists blinded to treatment allocation. RESULTS-: Mean blood pressure was 3.0/1.3 mm Hg lower with telmisartan compared with placebo at follow-up MRI. There was no statistically significant difference in progression of the mean periventricular WML score (least squares mean difference, 0.14; 95% CI, -0.12 to 0.39; P=0.29) and mean subcortical WML diameter (least squares mean difference, -0.35 mm; 95% CI, -1.00 to 0.31 mm; P=0.30) during follow-up between patients on telmisartan and placebo. CONCLUSIONS-: Treatment with telmisartan on top of existing antihypertensive medication did not result in significant blood pressure-lowering and did not prevent the progression of WML in patients with a recent ischemic stroke in this patient cohort. Our analysis is limited by the relatively short follow-up period. CLINICAL TRIAL REGISTRATION-: URL: http://clinicaltrials.gov. Unique Identifier: NCT00153062.

KW - antihypertensive treatment

KW - cerebral small vessel disease

KW - ischemic stroke

KW - magnetic resonance imaging

KW - secondary prevention

KW - telmisartan

KW - white matter lesion

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