Effect of cilnidipine vs losartan on cerebral blood flow in hypertensive patients with a history of ischemic stroke: a randomized controlled trial

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Abstract:

Hong K-S, Kang D-W, Bae H-J, Kim YK, Han M-K, Park J-M, Rha J-H, Lee Y-S, Koo J-S, Cho Y-J, Kwon SU, Kim SE, Park S-H. Effect of cilnidipine vs losartan on cerebral blood flow in hypertensive patients with a history of ischemic stroke: a randomized controlled trial. Acta Neurol Scand: 2010: 121: 51–57.

© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – 

The aim of this study was to compare the effects of antihypertensive agents on cerebral blood flow (CBF) in hypertensive patients with previous ischemic stroke. Materials and methods – 

In this double-blind, multi-center, non-inferiority trial, 196 patients were randomized to cilnidipine 10–20 mg or losartan 50–100 mg once daily for 4 weeks. Baseline and follow-up CBF as measured by single photon emission computed tomography were obtained in 167. The primary endpoint was the global CBF change. The secondary endpoints were the CBF change in the hemisphere ipsilateral to the index stroke, non-impairment of global CBF and blood pressure (BP) reduction. Results – 

Global CBF increased significantly in the cilnidipine arm (9.0 ± 29.6%, P = 0.0071) and the losartan arm (11.4 ± 31.4%, P = 0.0012), and these changes were not different between the two groups (P = 0.607). However, the estimated difference in percentage global CBF change between the two groups was −2.43% (97.5% CI, −13.06% to 8.21%), which crossed the predetermined non-inferiority margin of −8.6%. Ipsilesional hemispheric CBF change, non-impairment of global CBF and BP reduction were similar in the two groups. Conclusions – 

This trial failed to prove the non-inferiority of cilnidipine to losartan regarding global CBF change. Both the treatments, however, increase the global CBF despite BP lowering.

Keywords: cerebral blood flow; cilnidipine; hypertension; ischemic stroke; losartan

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1600-0404.2009.01299.x

Affiliations: 1: Department of Neurology, Clinical Research Center, Ilsan Paik Hospital, Inje University, Goyang, Korea 2: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 3: Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea 4: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea 5: Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea 6: Department of Neurology, Inha University Hospital, Incheon, Korea 7: Department of Neurology, Seoul Municipal Boramae Hospital, Seoul, Korea 8: Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Publication date: January 1, 2010

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