Table of Contents
ISRN Stroke
Volume 2013, Article ID 587954, 9 pages
http://dx.doi.org/10.1155/2013/587954
Clinical Study

Effect of Telmisartan on Cerebral and Systemic Haemodynamics in Patients with Recent Ischaemic Stroke: A Randomised Controlled Trial

1Division of Stroke, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Nottingham NG5 1PB, UK
2Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
3Division of Academic Radiology, University of Nottingham, Nottingham NG7 2UH, UK

Received 12 March 2013; Accepted 8 April 2013

Academic Editors: A. Ducruet, E. Gonzalez-Toledo, A. Slivka, and J. Wang

Copyright © 2013 Gillian M. Sare et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

High blood pressure (BP) is common in acute stroke and is independently associated with a poor outcome. Lowering BP might improve outcome if cerebral blood flow (CBF) is unaffected in the presence of dysfunctional autoregulation. We investigated the effect of telmisartan on systemic and cerebral haemodynamics in patients with recent stroke. Patients with ischaemic stroke (<5 days) were randomised to 90 days of telmisartan (80 mg) or placebo. CBF (primary outcome) was measured using xenon CT at baseline and 4 hours. BP and transcranial doppler (TCD) were performed at baseline, 4 hours after-treatment, and on days 4, 7, and 90. Cerebral perfusion pressure and zero filling pressure (ZFP) were calculated. Of a planned 24 patients, 17 were recruited. Telmisartan significantly accentuated the fall in systolic and diastolic BP over 90 days (treatment-time interaction , resp.) but did not alter BP at 4 hours after treatment (171/99 versus 167/87 mmHg), CBF, or CBF velocity. ZFP was significantly lower in the treatment group . Impairment at 7 days and dependency at 90 days did not differ between the groups. In this underpowered study, telmisartan did not significantly alter BP or CBF after the first dose. Telmisartan reduced BP over the subsequent 90 days and significantly lowered ZFP. This trial is registered with ISRCTN 41456162.