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

47 Scopus citations

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 1 2012

Keywords

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

ASJC Scopus subject areas

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

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    Weber, R., Weimar, C., Blatchford, J., Hermansson, K., Wanke, I., Möller-Hartmann, C., Gizewski, E. R., Forsting, M., Demchuk, A. M., Sacco, R. L., Saver, J. L., Warach, S., Diener, H. C., & 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, 43(9), 2336-2342. https://doi.org/10.1161/STROKEAHA.111.648576