Angiotensin receptor blockers following acute stroke

Abstract

Elevated blood pressure during the acute stroke period is associated with poor neurologic outcomes; however, treating blood pressure in this setting remains controversial. Interest in modulating the renin-angiotensin system in this setting has gained momentum because of neurohormonal properties, which may provide benefits beyond blood pressure control. The Scandinavian Candesartan Acute Stroke Trial (SCAST) was recently published describing the effects of candesartan in patients with hypertension during the acute stroke period. This study shows that lowering blood pressure with an ARB for 7 days poststroke does not improve 6-month neurologic outcomes. This article provides a context for a continuing discussion regarding the role of blood pressure lowering in patients following acute stroke.