Candesartan cilexetil in the management of blood pressure for acute and recurrent stroke in Japan: the Challenge-Stroke study

Abstract

The Challenge-Stroke study was conducted in Japanese patients initiated on candesartan cilexetil therapy within 3 months of suffering a stroke to investigate the clinical use of candesartan and its efficacy/safety in this therapeutic setting. A total of 869 patients formed the safety analysis set. In total, 79.6% of patients with brain hemorrhage (BH) and 60.2% with brain infarction (BI) began candesartan before post-stroke day 3 and 7, respectively. Baseline average blood pressure (BP) was 152.0/83.2 mmHg in the BH group and 165.2/89.8 mmHg in the BI group; this was reduced to 125.8/75.4 mmHg and 136.3/78.1 mmHg, respectively, at 1 year. The incidence of adverse drug reactions was 6.7 and 8.0%, respectively. There were 12 recurrent strokes in the BH group and 11 in the BI group after 1 year. The risk of recurrent stroke was significantly higher for BH patients with a final systolic BP ≥150 mmHg than for those with a final systolic BP <130 mmHg (hazard ratio: 6.807; p = 0.004). Aggressive antihypertensive therapy is currently employed in Japanese patients with acute stroke. Candesartan was safe and effective for BP control in acute stroke patients. Strict BP management may be useful for secondary prevention of stroke after BH.

Keywords::

• acute stroke
• antihypertensive therapy
• blood pressure
• candesartan cilexetil

Acknowledgements

The authors are grateful to the investigators at the following 84 institutions participating in the Challenge-Stroke Study: Nakamura Memorial Hospital, Hokkaido Neurosurgical Memorial Hospital, Kashiwaba Neurosurgical Hospital, Kushiro City General Hospital, Kohnan Hospital, Fukushima Red Cross Hospital, Hirosaki University Graduate School of Medicine, National Hospital Organization Sendai Medical Center, Yamagata City Hospital Saiseikan, Jichi Medical University, Kennan Hospital, Koga Red Cross Hospital, Institute of Brain and Blood Vessels (Mihara Memorial Hospital), Niigata Neurosurgical Hospital and Brain Research Center, Niigata Prefectural Shibata Hospital, Teikyo University Chiba Medical Center, Kimitsu Chuou Hospital, Nippon Medical School Chiba Hokusou, Saitama Red Cross Hospital, Saitama Medical Center, Saitama Medical University, Saitama Medical University International Medical Center, Juntendo University, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo Metropolitan Ohtsuka Hospital, Toshima Showa Hospital Clinic, National Center for Global Health and Medicine, Tokyo Koseinenkin Hospital, Showa University School of Medicine, NTT Medical Center Tokyo, Yokohama Shintoshi Neurosurgical Hospital, Sagamidai Hospital, Tokai University School of Medicine, Fujisawa City Hospital, Aichi Medical University, Japan Red Cross Nagoya Daiichi Hospital, Tosei General Hospital, Okazaki City Hospital, Saiseikan Matsusaka General Hospital, Komono Kosei Hospital, Ogaki Municipal Hospital, Toki General Hospital, Nishijima Hospital, Juntendo University Shizuoka Hospital, President of Iwata Neurosurgical Hospital, Takeda General Hospital, Takeda Hospital, Otsu Municipal Hospital, Kohka Public Hospital, Kanazawa Neurosurgical Hospital, Tominaga Hospital, Tane General Hospital, Saiseikai Ibaraki Hospital, Osaka Neurological Institute, Sakai Municipal Hospital, Baba Memorial Hospital, Shinko Hospital, Shinnittetu Hirohata Hospital, Ako Central Hospital, Japanese Labour Health and Welfare Organization Kagawa Rosai Hospital, The University of Tokushima Graduate School, Matsuyama Shimin Hospital, Ehime Prefectural Imabari Hospital, Chikamori Hospital, Suiseikai Kajikawa Hospital, Kawasaki Medical School, Ouji Neurosurgical Clinic, Takahashi Central Hospital, Saiseikai Yahata General Hospital, Omuta City Hospital, Saga Prefectural Hospital Koseikan, Shojima Neurosurgical Hospital, Juzenkai Hospital, Sankoukai Obama Hospital, Junwakai Memorial Hospital, Sanwakai Ikeda Hospital, Chubu Tokushukai Hospital, and others.

Financial & competing interests disclosure

This study was sponsored by Takeda Pharmaceutical Company Limited, Japan. Norio Tanahashi has received honoraria for the development of educational presentations from sanofi-aventis, Otsuka Pharmaceuticals and Takeda Pharmaceuticals. Jyoji Nakagawara has received honoraria for the development of educational presentations from sanofi-aventis, Otsuka Pharmaceuticals, Boehringer-Ingelheim, Mitsubishi-Tanabe Pharma and Takeda Pharmaceuticals. Yasushi Okada has received honoraria from Takeda Pharmaceuticals. Kazuo Minematsu has received honoraria for the development of educational presentations from pharmaceutical companies including Takeda, sanofi-aventis, Otsuka, Kyowa Kirin, Astellas Pharma, Boehringer-Ingelheim, Bayer-Schering Pharma, Mitsubishi-Tanabe Pharma, Dainippon Sumitomo Pharma, Novartis, Pfizer and Daiichi Sankyo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Writing assistance was provided by ContentEdNet and was funded by Takeda Pharmaceutical Company Limited.