Early Intervention with Atacand^® Improves Outcome for Patients with Acute Ischemic Stroke

First study to show benefits of early use of anti-hypertensives in stroke patients

Toronto, ON July 8, 2003 – In the ACCESS trial, Atacand^® (candesartan cilexetil) reduced overall mortality and vascular events by 47.5 per cent within one year following acute stroke in patients with elevated blood pressure. ACCESS (Acute Candesartan Cilexetil Evaluation in Stroke Survivors), was recently published in Stroke, a medical journal of the American Heart Association. 

These data revealed that the cumulative 12-month mortality was 2.9 per cent for Atacand^® versus 7.2 per cent for placebo (p=0.07), while the rate of vascular events post stroke was nearly half with Atacand^® compared with placebo (9.8 per cent compared with 18.7 per cent, p=0.026). Notably, the trial found that a seven-day course of Atacand^® when initiated no later than 72 hours post stroke significantly improved cardiovascular morbidity and mortality.

The ACCESS study is the first of its kind to clearly show the benefit and safety of using an angiotensin receptor blocker (ARB) or any anti-hypertensive in the acute stroke setting. 

“The ACCESS trial has the potential to change the way we treat hypertension in stroke patients in the acute setting. For years, experts have known the benefits of ARBs in treating high blood pressure to help prevent cardiovascular events. However, it was believed treating hypertension and lowering blood pressure in acute stroke patients could make the effects of the stroke worse – as it was thought that less oxygen was getting to the brain,” explains Dr. Ashfaq Shuaib, Professor and Director of Neurology at the University of Alberta. “ACCESS clearly shows early anti-hypertensive intervention with Atacand has a significant benefit in reducing vascular complications, including recurrent stroke and death.”

A double blind, randomized, multi-centre trial, ACCESS involved 342 patients from 53 centres across Germany. The study was designed to randomize 500 patients, but recruitment was halted early on the recommendation of the safety committee because interim results were so encouraging.

“The number of elderly in the Canadian population has been increasing in recent years leading to an increase in the number of deaths due to stroke and ischemic heart disease. The effects of stroke have considerable disability implications for patients and for healthcare costs,” commented Dr. Shuaib. “When it comes to the treatment of stroke, we know that the faster the treatment, the better the outcome. ACCESS provides evidence to suggest that in the prevention of recurrent strokes, faster is better too.”

The negative impact of hypertension and stroke in Canada is significant. Approximately 22 per cent of Canadian adults suffer from high blood pressure. Each year, between 40,000 and 50,000 people will suffer a stroke and 30-40 per cent of those will result in death. Each stroke survivor has a 20 per cent chance of having another stroke within two years. More than 300,000 Canadians are currently living with the effects of a stroke. The average acute care cost is approximately $27,500 per stroke. Overall, strokes cost the Canadian economy $2.7 billion a year.

Primary Prevention of Stroke Remains Key

The use of Atacand^® in the treatment of hypertension in the elderly has also been shown to reduce the risk of stroke. Data from the Study on COgnition and Prognosis in the Elderly (SCOPE), published in the May 2003 issue of the Journal of Hypertension indicates that Atacand^® significantly reduced the incidence of non-fatal stroke in elderly patients with hypertension by 28 per cent (p=0.041) versus the most commonly prescribed anti-hypertensives.¹

SCOPE also reported a trend towards a reduced risk of major cardiovascular events (11 per cent risk reduction; p=0.19) in the Atacand^® treatment group versus the control group (standard treatments like diuretics, calcium antagonists, beta-blockers and ACE inhibitors.)¹

SCOPE results are based on a randomized, double-blind study in 15 countries which evaluated the effects of Atacand^® on the clinical outcomes of 4,937 elderly patients (aged 70-89, with an average age of 76 years). These patients had mild hypertension – typical of those found in everyday practice. 
“We know there is a continuum of cardiovascular and cerebral risk associated with high blood pressure. ACCESS and SCOPE provide strong evidence of the benefits of Atacand^® in the treatment of hypertension,” added Dr. Shuaib. 

AstraZeneca is one of the leading pharmaceutical companies globally with a formidable product portfolio spanning seven major therapeutic areas: gastrointestinal, cardiovascular, oncology, pain control, respiratory, central nervous system and infection. AstraZeneca’s brands include Atacand^®, Atacand Plus^®, Crestor^®, Nexium^®, Losec^®, Casodex^®, Arimidex^®, Symbicort^®, Zomig^® and Seroquel^®. Recently ranked as one of the top 50 employers in Canada by The Globe and Mail’s Report on Business Magazine, AstraZeneca’s Canadian headquarters and manufacturing facilities are located in Mississauga, Ontario, with a state-of-the-art basic pain research centre based in Montreal, Quebec. For more information, visit the company's website at www.astrazeneca.ca.

Atacand^® is an angiotensin II type 1 (AT₁) receptor blocker indicated for the treatment of mild to moderate hypertension. Once-daily Atacand^® provides dose dependent, consistent blood pressure control with placebo-like tolerability throughout the dose range. Atacand^® Plus is a combination tablet of Atacand^® and low-dose hydrochlorothiazide, designed to provide an extra titration step for those who need more than monotherapy to control their blood pressure to the targets set in the latest treatment guidelines.