Document Detail


Benefits of the angiotensin II receptor antagonist olmesartan in controlling hypertension and cerebral hemodynamics after stroke.
MedLine Citation:
PMID:  19745828     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of this study was to assess the relative benefits of angiotensin II receptor blockers (ARBs) and calcium channel blockers (CCBs) on cerebral hemodynamics and rehabilitation outcome in hypertensive stroke patients. We randomly assigned 35 patients to either the olmesartan (n=18) or amlodipine (n=17) treatment groups for 8 weeks. Changes in cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) were quantified using xenon-CT and rehabilitation parameters were also measured. Over 24 h, olmesartan and amlodipine both reduced blood pressure (BP) to similar levels (systolic BP, -16.1+/-2.7 mm Hg vs. -15.7+/-3.1; diastolic BP, -9.2+/-2.9 vs. -8.6+/-3.3 mm Hg, respectively). In olmesartan-treated patients, CBF significantly increased in the affected and unaffected hemispheres, and CRC increased significantly in the affected hemisphere. No increases in CBF and CRC were observed in amlodipine-treated patients. Patients treated with olmesartan showed effective rates of improvement in hand (30.0%), upper extremities (40.0%) and lower extremities (100.0%), measured by Brunnstrom stage; these improvements were significantly different from those in amlodipine-treated patients for the total (P<0.02) and lower extremity (P<0.05) scores. There were no significant differences in Barthel indices and Mini-Mental State Examination (MMSE) scores. Olmesartan, but not amlodipine, had beneficial effects on CBF, CRC and rehabilitation outcomes in hypertensive stroke patients, by a mechanism independent of BP reduction and possibly by normalizing CBF autoregulation. Our results suggest that olmesartan may improve cerebral circulation and rehabilitation in hypertensive stroke patients in whom CBF autoregulation is impaired.
Authors:
Shuji Matsumoto; Megumi Shimodozono; Ryuji Miyata; Kazumi Kawahira
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2009-09-11
Journal Detail:
Title:  Hypertension research : official journal of the Japanese Society of Hypertension     Volume:  32     ISSN:  1348-4214     ISO Abbreviation:  Hypertens. Res.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-05     Completed Date:  2010-01-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9307690     Medline TA:  Hypertens Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  1015-21     Citation Subset:  IM    
Affiliation:
Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. shushu@m.kufm.kagoshima-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Acetazolamide / therapeutic use
Adult
Aged
Amlodipine / therapeutic use
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Calcium Channel Blockers / therapeutic use
Cerebrovascular Circulation / drug effects*
Diuretics / therapeutic use
Double-Blind Method
Female
Humans
Hypertension / drug therapy*,  physiopathology
Imidazoles / therapeutic use*
Male
Middle Aged
Prospective Studies
Stroke / drug therapy*,  physiopathology,  rehabilitation
Tetrazoles / therapeutic use*
Tomography, X-Ray Computed
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Diuretics; 0/Imidazoles; 0/Tetrazoles; 0/olmesartan; 59-66-5/Acetazolamide; 88150-42-9/Amlodipine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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