Reduced Stroke Risk With Blood Pressure, Cholesterol-Lowering Drugs

In patients at intermediate risk for cardiovascular disease, fixed-dose candesartan plus hydrochlorothiazide with rosuvastatin reduced the incidence of first stroke, according to a study presented at the 2018 International Stroke Conference held January 24-26 in Los Angeles, California.¹

Researchers used a 2×2 factorial design and randomly assigned 12,705 participants at intermediate risk for cardiovascular disease to fixed-dose candesartan 16 mg plus hydrochlorothiazide 12.5 mg/d or placebo and rosuvastatin 10 mg/d or placebo. Approximately half of the participants were women and mean age was 66. At baseline, mean blood pressure (BP) was 138/82 mm Hg and the BP difference between treatment groups averaged 6/3 mm Hg during follow up.

Candesartan/hydrochlorothiazide reduced stroke by 20% (CI, 0.59-1.08; P =.14) and rosuvastatin reduced stroke by 30% (CI, 0.52-0.95). Stroke was reduced by 42% (CI, 0.37-0.90; P =.02) in participants who were in the upper third of systolic BP (>143.5 mm Hg) in a prespecified subgroup analysis.

Stroke was reduced by 44% (95% CI, 0.36-0.87; P =.009) in participants who were assigned both candesartan/hydrochlorothiazide and rosuvastatin.

In a statement to the American Heart Association, the researchers noted that they are looking to develop a single pill that offers the same benefits as taking multiple pills for lowering blood pressure and cholesterol.²

References

1. Bosch J, Lonn E, Zhu J, et al; for the HOPE-3 Investigators. First stroke reduced 44 percent by well tolerated medications. Stroke outcomes from the Heart Outcomes Prevention Evaluation 3 study. Presented at: the 2018 International Stroke Conference. January 24-26, 2018; Los Angeles, California. Presentation 104.
2. Combining drugs that lower blood pressure and cholesterol could do more to prevent stroke [press release]. Los Angeles, CA: American Heart Association/American Stroke Association; January 25, 2018.