MOSES Study: Eprosartan Lowers Risk of Second Stroke
Hypertensive patients who have had a stroke may be spared from further recurrence of stroke or other cerebrovascular and cardiovascular events by treating them with the angiotensin-2 receptor-blocker eprosartan.
IniTIAl results of the landmark Mortality and Morbidity After Stroke: Eprosartan vs. Nitrendipine in Secondary Prevention (MOSES) study have shown a significant 21-percent reduction in total mortality and total cerebrovascular and cardiovascular events among patients treated with eprosartan for two to four years.
The results, presented by lead investigator Prof. Joachim Schrader at the 26th Congress of the European Society of Cardiology held August 28 to September 1 in Munich, Germany, also showed that treatment with eprosartan significantly reduced first-time cardiovascular events by 30 percent. Stroke recurrence, transient ischemic attack (TIA), and prolonged reversible ischemic neurological deficit (PRIND) was lowered by 25 percent.
These benefits were on top of the blood-pressure-lowering effects of the drug, according to the researchers.
The study involved 1,405 hypertensive patients who have had a stroke or TIA and are at risk of another stroke or any other cardiovascular or cerebrovascular event. They were randomized to receive 600 mg eprosartan (710 patients) or 10 mg nitrendipine (695).
The patients also had a concomitant disease like diabetes mellitus (36 percent in the eprosartan group and 37.7 percent in the nitrendipine group), hyperlipidemia (54.3 and 51.9 percent), coronary heart disease (27.8 and 25.3 percent), and hyperuricemia (17.6 and 18.5 percent). The average follow-up period was 2.5 years.
The primary end points were total mortality and total number of cardiovascular and cerebrovascular events. Secondary end points were changes in mean blood pressure and in mental capacity and status measured by the Barthel index, Rankin scale, and mini mental state examination score. The cardiovascular and cerebrovascular events were also evaluated individually as secondary end points.
BEYOND BP REDUCTION
Schrader, head of internal medicine at St. Josef's Hospital in Cloppenburg, Germany, said the MOSES study was the first that compared two antihypertensive drugs in a well-defined group of hypertensive patients with very tight clinical controls and which achieved early and comparable blood-pressure control.
In his presentation, Schrader noted that 75.5 percent of patients in the eprosartan group and 77.7 percent in the nitrendipine group achieved normotensive status (below 140/90 mm Hg) within three months. The BP was sustained throughout the observation phase during which the BP was measured in the clinic at three, six, 12, 18, and 24 months after commencing treatment. Twenty-four-hour ambulatory blood pressure was also taken at the start of treatment and at 12 and 24 months to get a more accurate measure of BP.
"At the end of the study, blood pressure was 137/80.8 in the eprosartan group and 136/80.2 in the nitrendipine group," he said, noting that this was achieved in 71.1 percent of patients in the eprosartan group and 72.5 percent in the nitrendipine group.
Researchers say that since both agents achieved similar reductions in blood pressure, the reduced incidence of cerebrovascular and cardiovascular events among patients treated with eprosartan indicates that these were achieved independently of blood-pressure reduction.
Schrader said the results showed significant advantage for eprosartan against nitrendi-pine in the primary end points (including recurrent events), cerebrovascular events, and first-time cardiovascular event. No significant difference was noted in the other end points.
Fewer combined cardiovascular and cerebrovascular events took place in the eprosartan group (206) than in the nitren-dipine group (255), "a difference of about 21 percent (p = 0.014)," Schrader said.
There were also fewer fatal or nonfatal cerebrovascular events among patients given eprosartan (102) as against those given nitrendipine (134) (p = 0.02).
Another significant difference was seen in first-time cardiovascular events-60 in the eprosartan group and 84 in the nitrendipine group (p = 0.03).
KILLER STROKE
Stroke is the third leading cause of death worldwide, next only to heart disease and cancer. Worldwide, more than 20 million people suffer a stroke every year. More than half of these (12.7 million) is caused by hypertension.
About 25 percent of those who suffer a stroke die. Many of those who survive suffer from disability and impaired cognitive function. They also face a 15-times-normal risk of suffering another stroke, which may be devastating, if not fatal. Among those who survive a first stroke, eight percent suffer another stroke within one year and 17 percent experience another stroke within the succeeding five years. Their risk of suffering from other kinds of cardiovascular or cerebrovascular events is also higher.
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