Systematic Review: Pre-Stroke Use of Angiotensin Receptor Blockers and Stroke Outcomes

https://doi.org/10.19106/JMedSci005002201815

Ivana Purnama Dewi(1*), Virandra B. Kusmanto(2), Kristin Purnama Dewi(3), Rizaldy Pinzon(4)

(1) Duta Wacana Christian University
(2) 
(3) 
(4) 
(*) Corresponding Author

Abstract


Background: Hypertension is the major risk factor and the most important modifiable risk factor for stroke. Angiotensin Receptor Blockers (ARB) are widely used in patient at high risk of cardiocerebrovascular events. The objective of this literature review was to determine the efficacy of pre-stroke use of ARB on stroke outcomes.

Methods: Major medical databases (PubMed, MEDLINE, Clinical Key, Cochrane Library, EMBASE) were systematically searched using keyword: “hypertension”, “ARB”, “stroke”, and “outcome”. The search were limited to clinical trials published within the last 10 years, written in English, with full-text availability. We used GRADE Working Group to measure the quality of evidence.

Results: Four clinical studies, three retrospective studies and one nationwide population-based cohort study met our inclusion criteria with total of 102.644 patients for analysis. The scientific quality of the studies varied from poor (1 study), moderate (1 study), and high quality (2 studies). Generally, the subjects of the studies were acute ischemic stroke patients. Three studies showed pre-stroke use of ARB were significantly associated with better stroke outcomes. Only one study found different result whereas pre-stroke use of ARB did not appear to affect stroke outcomes. Outcome of the studies was explored according to morbidity (severity and functional status upon discharge) and mortality (30-days mortality or in-hospital mortality). Several limitations were present, including non-random treatment assignment, retrospective study design, and lack of data for longitudinal medication exposure in observational studies.

Conclusions: This systematic review shows evidence that there is possible benefit of pre-stroke ARB treatment in relation to better ischemic stroke outcomes. However, further studies with better research method quality are still needed. The efficacy of ARB treatment in relation to other type of stroke outcomes also needs to be furtherly examined.

Keywords: ARB, pre-stroke, benefit, prognosis

 

Makalah ini dipresentasikan dalam Poster Session 11th Scientific Meeting of Indonesian Society of Hypertension, 24-26 February 2017


Keywords


ARB, pre-stroke, benefit, prognosis

Full Text:

PDF


References

Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World Neurosurg [Internet]. 2011;76(6 SUPPL.):S85–90. 2. Cao Q, Zhou S, Cai B, Wang Q, Zhang J, Shi R, et al. The impacts of premorbid hypertension treatment on functional outcomes of ischemic stroke. J Neurol Sci [Internet]. 2016;363(January 2013):1–4. 3. K. G, G. G, A. C, Grabska K, Gromadzka G, Członkowska A. Prestroke antihypertensive therapy: Effect on the outcome. Clin Exp Hypertens [Internet]. 2013;35(2):141–7. 4. Fournier A, Messerli FH, Achard JM, Fernandez L. Cerebroprotection mediated by angiotensin II. A Hypothesis Supported by the recent Randomized Clinical Trials. J Am Coll Cardiol [Internet]. 2004 Apr;43(8):1343–7. 5. Mancia G, Kjeldsen SE, Zappe DH, Holzhauer B, Hua TA, Zanchetti A, et al. Cardiovascular outcomes at different on-treatment blood pressures in the hypertensive patients of the VALUE trial. Eur Heart J. 2016;37(12):955–64. 6. Chrysant SG, Chrysant GS. The pleiotropic effects of angiotensin receptor blockers. J Clin Hypertens(Greenwich). 2006;8(4):261–8. 7. Villapol S, Saavedra JM. Neuroprotective effects of angiotensin receptor blockers. Am J Hypertens. 2015;28(3):289–99. 8. Miyamoto N, Tanaka Y, Ueno Y, Tanaka R, Hattori N, Urabe T. Benefits of prestroke use of angiotensin type 1 receptor blockers on ischemic stroke severity. J Stroke Cerebrovasc Dis [Internet]. 2012;21(5):363–8. 9. Fuentes B, Fernández-Domínguez J, Ortega-Casarrubios MÁ, SanJosé B, Martínez-Sánchez P, Díez-Tejedor E. Treatment with angiotensin receptor blockers before stroke could exert a favourable effect in acute cerebral infarction. J Hypertens [Internet]. 2010 Mar;28(3):575–81. 10. Sundboll J, Schmidt M, Horvath-Puho E, Christiansen CF, Pedersen L, Botker HE, et al. Preadmission use of ACE inhibitors or angiotensin receptor blockers and short-term mortality after stroke. J Neurol Neurosurg Psychiatry. 2015;86(7):748–54. 11. Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Papadopoulou M, Kazantzidou P, et al. Effects of different classes of antihypertensive agents on the outcome of acute ischemic stroke. J Clin Hypertens (Greenwich). 2015;17(4):275–80. 12. Drenthen W, Voors AA, Kappelie JLJ, Veldhuisen DJ Van. Cerebroprotective effect of angiotensin 1. 1(At I). 13. Fournier A, Achard JM, Boutitie F, Mazouz H, Mansour J, Oprisiu R, et al. Is the angiotensin II Type 2 receptor cerebroprotective? Curr Hypertens Rep. 2004;6:182–9. 14. Sadoshima J. Cytokine actions of angiotensin II. Circ Res. 2000;86(12):1187–9. 15. Ito T, Nishimura Y, Saavedra J. Pre-treatment with candesartan protects from cerebral ischaemia. J Renin Angiotensin Aldosterone Syst. 2001;2(3):174–9.



DOI: https://doi.org/10.19106/JMedSci005002201815

Article Metrics

Abstract views : 1489 | views : 1877


Bookmark and Share


Copyright (c) 2018 Ivana Purnama Dewi, Virandra B. Kusmanto, Kristin Purnama Dewi, Rizaldy Pinzon

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.