Abstract
<p class="ParaAttribute0">Objective<strong>:</strong> To compare the beneficial effects of telmisartan with other anti-hypertensive agents during stroke with respect to improvement from neurological dysfunction.</p><p class="ParaAttribute0"><strong>Methods: </strong>A prospective observational study was performed on 98 eligible study participants. The blood pressure, National Institute of Health Stroke Scale (NIHSS) score and power of limbs were noted. The data were analysed using one-way Analysis Of Variance (ANOVA) followed by Dunnett’s Multiple Comparison Test.<strong></strong></p><p class="ParaAttribute0"><strong>Results: </strong>Among 150 randomised patients, 110 met the inclusion criteria, and 98 came for follow-up whose data was recorded. Telmisartan showed significant improvement in total NIHSS score compared to amlodipine (P ≤ 0.01) and mannitol (P ≤ 0.01). The mean reduction in SBP and DBP was significant with respect to telmisartan compared to amlodipine (P≤ 0.01). Telmisartan showed significant improvement of power in right upper limb (UL) compared to amlodipine (P ≤ 0.05) and mannitol (P ≤ 0.01). Improvement of power in right lower limb (LL) showed significance with respect to telmisartan compared to mannitol (P ≤ 0.05). Significant improvement of power in left LL was observed in telmisartan compared to mannitol (P ≤ 0.01).<strong></strong></p><p class="ParaAttribute0"><strong>Conclusion: </strong>Blood pressure reduction is an inevitable component of stroke treatment. Anti-hypertensive treatment seems to be highly efficacious in protecting patients against stroke and stroke recurrence, especially on long term basis. Thus, telmisartan provides a viable insight into the stroke prevention strategy and may be prudent to consider as a reasonable add-on therapy.</p>
Highlights
Telmisartan has a dual role of controlling blood pressure as well as exhibiting neuroprotection in brain attack conditions which may benefit stroke patients
According to the guidelines by the British Hypertension Society and National Institute for Health and Clinical Excellence (NICE), the risk of stroke is reduced by 16% in patients on Angiotensin Receptor Blockers (ARB)
The results reported by the Losartan Intervention for Endpoint reduction (LIFE) investigators revealed that there is a substantial reduction in stroke events (40%) and CV mortality (46%) in losartan-based anti-hypertensive regimen compared to atenololtreated patients [4]
Summary
Telmisartan has a dual role of controlling blood pressure as well as exhibiting neuroprotection in brain attack conditions which may benefit stroke patients. Previous studies indicate that Angiotensin Converting Enzyme Inhibitors (ACE-I) and ARB’s are more effective in recurrent stroke prevention than other anti-hypertensive agents [1] They exert multiple anti-atherogenic actions and reduce clinical events in high-risk patients. Among the ARB’s used in the treatment of stroke, telmisartan has been found to directly ameliorate interleukin 1-beta induced a neuronal inflammatory response, by inhibition of oxidative stress and the c-Jun n-terminal kinases (JNKs) pathway. It attenuates the excitatory amino acid by controlling cytokines and reactive oxygen species released during ischemia. The study determined the clinical significance of preferring telmisartan over other antihypertensive agents in stroke patients
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