1Department of Internal Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
2Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
3Faculty of medicine, Vilnius University and Department of Neurology, Vilnius University Santariskiu Klinikos Hospital, Vilnius, Lithuania
4Department of Neurology, University Clinics of Tartu, Tartu, Estonia
5Department of Internal Medicine, St. Josefs Hospital, Cloppenburg, Germany
6Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
7Department of Neurology, Turku University Central Hospital, Turku, Finland
8Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
9Department of Neurology and Vesalius Research Center (VIB), University Hospital Leuven, Leuven, Belgium
Background: It has long been debated whether high blood pressure should be lowered in the acute phase of stroke. ACCESS (Stroke 2003;34:1699) suggested a beneficial effect of the angiotensin receptor blocker candesartan in the acute phase of stroke, but these findings need to be confirmed in new, large trials.
Methods: SCAST is an international, investigator-initiated, randomising, placebo-controlled, double blinded trial of candesartan in acute stroke. Patients presenting within 30 hours of stroke (ischaemic or haemorrhagic) and systolic blood pressure > 140 mmHg are randomly assigned to candesartan or placebo for 7 days (doses increasing from 4 to 16 mg once daily). The follow-up period is 6 months. Primary effect variables: i) Death or major disability at 6 months; ii) Vascular death, myocardial infarction or stroke during the first 6 months.
Status: The last patient will be included in February 2010, when approximately 2,000 patients will have been included from >100 centres in Norway, Sweden, Denmark, Belgium, Finland, Germany, Poland, Estonia and Lithuania. Patient characteristics at baseline: Mean age 71 years; blood pressure 171/90 mmHg; ischaemic stroke 85%; haemorrhagic stroke 15%. Preliminary, blinded results will be presented at the meeting.
Funding: Basic funding from Norwegian health authorities. Trial drugs and unconditional grants from AstraZeneca and Takeda.
Conclusion: SCAST is to date the largest trial of blood pressure lowering treatment in the acute phase of stroke, and the first large trial with an angiotensin receptor blocker for this indication.