Secondary stroke prophylaxis: ARB bests calcium antagonist

The angiotensin receptor blocker (ARB) eprosartan is superior to the calcium antagonist nitrendipine in secondary stroke prophylaxis in patients with hypertension, Hans-Christian Diener, MD, reported at the ASA's International Stroke Conference 2005.

The angiotensin receptor blocker (ARB) eprosartan is superior to the calcium antagonist nitrendipine in secondary stroke prophylaxis in patients with hypertension, Hans-Christian Diener, MD, reported at the ASA's International Stroke Conference 2005.

"Until now, there have been only placebo-controlled trials in secondary stroke prevention," said Dr Diener, chairman and professor of neurology, University of Essen, Germany.

In the Morbidity and Mortality after Stroke (MOSES) trial, eprosartan and nitrendipine were compared in 1,405 hypertensive patients (mean age: 68 years) who had suffered a cerebral event during the preceding 24 months. Patients were randomized to eprosartan 600 mg/d or nitrendipine 10 mg/d.

The primary end point-the composite of total mortality and all cardiac and cerebrovascular events-was reached by 206 patients assigned to eprosartan and 255 assigned to nitrendipine, corresponding to a 21% reduction with eprosartan (P=.014). The number of events per 100 person-years was reduced from 16.71 in the nitrendipine group to 13.25 in the eprosartan group.

The reduction in the primary end point with eprosartan was driven by significant reductions in cardiovascular events (P=.06) and cerebrovascular events (P=.02), with no effect on mortality.