Effects of candesartan in acute stroke on activities of daily living and level of care at 6 months

Objective:The Scandinavian Candesartan Acute Stroke Trial (SCAST) indicated that blood pressure-lowering treatment with candesartan in the acute phase of stroke has a negative effect on functional outcome at 6 months, measured by the modified Rankin scale. We wanted to see if similar effects can be observed on activities of daily living and level of care.Methods:SCAST was an international multicentre, randomized and placebo-controlled trial of candesartan in 2029 patients recruited within 30h of acute ischaemic or haemorrhagic stroke. Treatment lowered blood pressure by 5/2mmHg from day 2 onwards, and was administered for 7 days. At 6 months, activities of daily living were assessed by the Barthel index, and categorized as dependency' (55 points), assisted dependency' (60-90), or independency' (95). Level of care was categorized as living at own home without public help', living at home with public help, or in institution for rehabilitation', or living in institution for long or permanent stay'. We used ordinal and binary logistic regression for statistical analysis, and adjusted for predefined key variables.Results:Data were available in 1825 patients, of which 1559 (85%) patients had ischaemic and 247 (13%) had haemorrhagic stroke. There were no statistically significant effects of candesartan on the Barthel index or on level of care (adjusted common odds ratio for poor outcome 1.09, 95% confidence interval 0.88-1.35, P=0.44; and odds ratio 1.05, 95% confidence interval 0.82-1.34, P=0.69, respectively). In the individual Barthel index domains, there were also no statistically significant differences.Conclusion:Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months. This result is compatible with the results of the main analysis of the modified Rankin scale, and supports the conclusion that there is no indication for routine blood pressure treatment with candesartan in the acute phase of stroke.