• Else Charlotte Sandset, Mirza Jusufovic, Per Morten Sandset, Philip M W Bath, Eivind Berge, and SCAST Study Group.
• From the Department of Neurology (E.C.S., M.J.), Department of Haematology (P.M.S.), and Department of Internal Medicine (E.B.), Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway (P.M.S.); and Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.). else@sandset.net.
• Stroke. 2015 Mar 1;46(3):877-9.

Background And PurposeThe Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of blood pressure-lowering treatment with candesartan in acute stroke. We have investigated whether the effect of treatment is different in different subtypes of ischemic stroke.MethodsSCAST was a randomized- and placebo-controlled trial of candesartan in 2029 patients presenting within 30 hours of ischemic or hemorrhagic stroke and systolic blood pressure ≥140 mm Hg. Ischemic stroke subtype was categorized by the Oxfordshire Community Stroke Project classification. There were 2 primary effect variables: the composite vascular end point of vascular death, myocardial infarction, or stroke during the first 6 months and functional outcome at 6 months.ResultsA total of 1733 patients with ischemic stroke were included: total anterior circulation infarcts in 129, partial anterior in 850, posterior in 236, and lacunar in 510 patients. For functional outcome there was a significant trend toward a better effect of candesartan in patients with larger infarcts (total anterior circulation or partial anterior circulation) than in patients with smaller infarcts (lacunar infarction; P=0.02). For the composite vascular end point, there were no differences in treatment effect.ConclusionsThe results suggest that the effect of blood pressure-lowering treatment with candesartan may differ according to different types of acute ischemic stroke, but this needs to be confirmed in future trials.Clinical Trial Registration Urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00120003.© 2015 American Heart Association, Inc.

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