Enalapril with Folic Acid Reduces Stroke Risk in Hypertension

HealthDay News — The combined use of enalapril and folic acid in patients with hypertension is associated with reduced risk of first stroke, according to a study published online in the Journal of the American Medical Association and presented at the annual meeting of the American College of Cardiology.

Yong Huo, MD, from the Peking University First Hospital in Beijing, and colleagues examined whether enalapril plus folic acid is more effective in reducing first stroke than enalapril alone. Data were included for 20,702 adults with hypertension without history of stroke or myocardial infarction (MI). The participants were randomized to receive a single pill combination containing enalapril and folic acid (10,348 participants) or a tablet with enalapril alone (10,354 participants).

The researchers found that the enalapril-folic acid group had a significant risk reduction in first stroke compared with the enalapril alone group (2.7 versus 3.4%; hazard ratio, 0.79) during a median treatment duration of 4.5 years. The enalapril-folic acid group also had reduced risk of first ischemic stroke (hazard ratio, 0.76) and composite cardiovascular events consisting of cardiovascular death, MI, and stroke (hazard ratio, 0.80). There were no significant between-group differences noted in the risk of hemorrhagic stroke, MI, and all-cause deaths.

“These findings are consistent with benefits from folate use among adults with hypertension and low baseline folate levels,” the authors write.

Several authors disclosed financial ties to Shenzhen AUSA Pharmed, which partially funded the trial.


  1. Huo Y et al. JAMA. 2015; doi:10.1001/jama.2015.2274.