Antihypertensives and Statin Therapy for Primary Stroke Prevention (A Secondary Analysis of the HOPE-3 Trial).

Intro: The HOPE-3 trial (Heart Outcomes Prevention Evaluation–3) found that antihypertensive therapy combined with a statin reduced the first stroke among people at intermediate cardiovascular risk. In this study, secondary analyses of predefined stroke outcomes for each randomized intervention, was reported by stroke subtype, independent predictors, treatment effects in key subgroups, and absolute risk reductions. Methods: Using a 2-by-2 factorial design, 12 705 participants from 21 countries with vascular risk factors but without overt cardiovascular disease were randomized to candesartan 16 mg plus hydrochlorothiazide 12.5 mg daily or placebo and to rosuvastatin 10 mg daily or placebo. The effect of the interventions on stroke subtypes was assessed. Results: During 5.6 years of follow-up, Baseline Systolic & Diastolic blood pressure (138/82 mm Hg) was reduced by 6.0 & 3.0 mm Hg and LDL-C (low-density lipoprotein cholesterol; 3.3 mmol/L) was reduced by more than 26.5 % with Rosuvastatin. 169 strokes occurred (117 ischemic, 29 hemorrhagic, 23 undetermined). Blood pressure-lowering by Candesartan did not significantly reduce stroke Rosuvastatin significantly reduced the risk of the first stroke by 30% (HR, 0.70 [95% CI, 0.52–0.95]), but did not significantly affect hemorrhagic (HR, 1.22 [95% CI, 0.59–2.54]) or strokes of undetermined origin (HR, 1.29 [95% CI, 0.57–2.95]). However, the combination of statin and BP-lowering lead to a substantial and significant 44% risk reduction in strokes indicating that this combination will have a large impact on the primary prevention of strokes in an average-risk population. Results Among people at intermediate cardiovascular risk but without overt cardiovascular disease, a low dose of rosuvastatin 10 mg daily significantly reduced the first stroke. Blood pressure-lowering combined with rosuvastatin reduced ischemic stroke by 59%. the combination of BP lowering and statins should be considered for CVD prevention including strokes in individuals at intermediate risk. Globally this could lead to the avoidance of millions of strokes per year if these treatments were widely used. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.