Treatment with angiotensin receptor blockers before stroke could exert a favourable effect in acute cerebral infarction

Introduction Evidence from experimental and clinical studies is accumulating about the possible cerebral protective properties of antithypertensive drugs, mainly angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEI). Our aim was to analyse the impact of prestroke use of antihypertensive drugs on stroke severity and outcome. Methods We analysed 1968 consecutive patients with first-ever acute cerebral infarction admitted to an acute stroke unit. Stroke severity was evaluated using the Canadian Neurological Scale and the modified Rankin Score (mRS) was used to evaluate the outcome at discharge. Results Previous diagnosis of arterial hypertension was reported in 1212 patients and 73% were on antihypertensive treatment. No significant differences in stroke severity were found between patients with or without previous arterial hypertension, either in patients with or without antihypertensive treatment. Patients taking antihypertensive drugs at stroke onset had lower rates of poor outcome than those not on antihypertensive treatment (47 vs. 53%; P= 0.047) and those taking ARB had better outcomes than those without ARB (mRS ≤ 2: 75 vs. 65.8%; P = 0.029), with no differences in the analysis of other antihypertensive drugs. The multivariable logistic regression analysis showed that previous treatment with ARB was independently associated with reduced stroke severity (OR: 0.40; 95%CI 0.24-0.65; P<0.001) and against poor outcome (OR: 0.41; 95%CI 0.23-0.78; P= 0.003). Conclusion Our study suggests that prestroke treatment with ARB may be associated with reduced stroke severity and also with better outcome. This finding agrees with experimental data that suggest a cerebral protective effect.