Abstract
Background: There has been considerable interest in the effect of angiotensin receptor blockers on cognitive function after stroke. We wanted to assess the effect of candesartan in the acute phase of stroke on long-term cognitive function, in the Scandinavian Candesartan Acute Stroke Trial. Methods: SCAST was a randomised, placebo-controlled trial of candesartan in 2,029 patients with acute stroke and systolic BP >140 mm Hg. Treatment was administered for 7 days. Cognitive function was assessed at 6 months by the Mini Mental State Examination (MMSE). MMSE scores (range 0 – 30) was divided into three groups: no cognitive impairment (scores 27 – 30), possible (24 – 26), and definite cognitive impairment (0 – 23). We used ordinal logistic regression, adjusting for age, gender, cause of stroke (ischaemic vs. all other), systolic blood pressure, and SSS score at baseline. Results: Data on MMSE score were available on 1642 patients (81%). Median score was 28 in both groups. There was no difference in risk of cognitive impairment in the two groups (common OR 0.98, 95% CI 0.82 – 1.22, p = 0.99).Conclusion: Candesartan showed no effect on cognitive function. This result is in accordance with the SCAST main result, and supports the conclusion that there is no indication for routine blood pressure lowering treatment with candesartan in the acute phase of stroke.
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