The established antihypertensive agent TEVETEN® (eprosartan) has now been shown to offer effective protection against cerebrovascular and cardiovascular events in hypertensive patients with a previous stroke, over and above that offered by blood pressure reduction.

Initial results from the landmark MOSES* study, presented by Professor Joachim Schrader at the XXVI Congress of the European Society of Cardiology in Munich, showed that blood pressure was equally well controlled when hypertensive patients with a history of stroke were treated with either TEVETEN®-based or nitrendipine-based therapies. However, there was a significant reduction of 20% in the primary endpoint (total mortality and total cardiovascular and cerebrovascular events) in the TEVETEN® group. In addition, there was a significant reduction of 25% in the recurrence of stroke and associated disease (transient ischaemic attack [TIA] and prolonged reversible neurological deficit [PRIND]), and a significant reduction of 30% in first-time cardiovascular events in patients treated with TEVETEN®.

TEVETEN® is a member of the class of drugs known as angiotensin-II receptor antagonists, which target the renin-angiotensin-aldosterone system. Other drugs from this lass have previously demonstrated cardio- and cerebroprotective effects in patients at risk of stroke. However, earlier studies focused on patients who, although at risk, have not yet had a stroke. These studies helped to establish the value of antihypertensive treatment in primary stroke prevention, but until now there were few data on the effectiveness of these drugs in preventing recurrent stroke.

MOSES is the first study to specifically compare the outcomes of alternative antihypertensive treatment in patients with a history of stroke. The calcium channel blocker nitrendipine was chosen as the comparator agent because of its success in the Syst-Eur study,' where treatment reduced the risk of stroke by 42% in elderly patients with systolic hypertension.

In the MOSES study, both nitrendipine and TEVETEN® produced impressive reductions in blood pressure, with approximately 75% of patients in each group reaching the target blood pressure as determined by ambulatory blood pressure monitoring. Since both agents produced similar reductions in blood pressure, the reduced incidence of cerebrovascular and cardiovascular events in patients receiving TEVETEN® indicates that these benefits are achieved independently of blood pressure reductions.

Throughout the world, over 20 million people each year suffer a stroke. Approximately 25% of strokes are fatal but among the 75% who survive, stroke is a cause of considerable disability. Many patients never recover full function and become dependent on others for help with everyday living. They are also at high risk of suffering a further stroke - compared with the population as a whole, their risk of stroke is multiplied 15¬fold. A second stroke may be truly devastating.

MOSES has now demonstrated the efficacy of TEVETEN® in reducing the incidence of recurrent stroke-related disease. These results may therefore have significant implications for the choice of antihypertensive prescribed for these patients.

* MOrbidity and mortality after Stroke - Eprosartan compared with nitrendipine for Secondary prevention.

Reference

1-Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997;350:757-764.

Joachim Schrader is Head of Internal Medicine at St Josefs Hospital, Cloppenburg, Germany. Prof. Schrader's research interests include stroke and dementia, and he specializes in the diagnosis and treatment of arterial hypertension, focusing in particular on 24-hour long-term blood pressure monitoring. The main focus of his research is the link between hypertension and stress, and the effect of hypertension on renal function. After training in Gottingen, Germany, and working for many years in the Centre for Internal Medicine at the local University Hospital where, among other things, he was in charge of the area of arterial hypertension in the nephrology/rheumatology department, in 1994 he was appointed Senior Consultant in the Medical Clinic in Cloppenburg.
Prof. Schrader is a member of the Board of the Deutsche Hochdruckliga (German Hypertension League), Chairman of the Stroke Commission of the Deutsche Hochdruckliga, and also a holder of the Pro Corde special prize for hypertension.

Related Links

Moses Study
Teveten®
Cardiology
Scientific