The Study on COgnition and Prognosis in the Elderly (SCOPE) - major CV events and stroke in subgroups of patients
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Peter Trenkwalder1, Dag Elmfeldt, Albert Hofman
1Department of Internal Medicine, Starnberg Hospital, Ludwig Maximilian University Munich, Osswaldstrasse 1, D-82319 Starnberg, Germany. peter.trenkwalder@klinikum-starnberg.de
Insights
Candesartan therapy in elderly hypertension patients significantly reduced strokes by 28%. The drug showed particular benefit for major cardiovascular events in patients with a prior stroke history.
Area of Science:
- Cardiovascular Medicine
- Geriatrics
- Pharmacology
Background:
- Elderly patients with mild to moderate hypertension often require effective treatment to prevent cardiovascular events.
- The Study on COgnition and Prognosis in the Elderly (SCOPE) investigated candesartan's impact on cardiovascular outcomes in this demographic.
Purpose of the Study:
- To assess the effect of candesartan on cardiovascular outcomes in elderly patients with hypertension.
- To analyze treatment effects across various patient subgroups, including those with a history of stroke.
Main Methods:
- Randomized controlled trial comparing candesartan (8-16 mg daily) to placebo in 4,937 elderly patients.
- Analysis of pre-specified subgroups based on age, gender, diabetes, smoking, prior stroke, and cardiovascular risk.
- Evaluation of cardiovascular events and stroke incidence.
Main Results:
- Candesartan resulted in a modest 3/2 mmHg greater blood pressure reduction compared to placebo.
- A significant 28% reduction in non-fatal stroke was observed with candesartan (p=0.04).
- Major cardiovascular events showed a non-significant 11% reduction (p=0.19), but benefits were consistent across subgroups.
- A pronounced 64% reduction in major cardiovascular events was noted in patients with a prior stroke (p=0.004).
Conclusions:
- Candesartan-based therapy demonstrates consistent favorable effects on stroke reduction in elderly hypertensive patients across various subgroups.
- The cardiovascular benefits of candesartan were particularly significant in patients with a history of stroke.
Abstract:
The Study on COgnition and Prognosis in the Elderly (SCOPE) assessed the effect of candesartan on cardiovascular outcomes in elderly patients with mild to moderate hypertension. Patients were randomized to candesartan 8-16 mg daily (n = 2477) or placebo (n =2460). Due to extensive add-on therapy, blood pressure reduction was only about 3/2 mmHg greater in the candesartan group than in the control group. Nevertheless, non-fatal stroke was reduced by 28% (p = 0.04) in the candesartan group compared to the control group, and there was a non-significant 11% reduction in major cardiovascular events (p = 0.19). This report provides results in pre-specified subgroups of patients (age, gender, diabetes, history of stroke, smoking and cardiovascular risk at randomization). Reductions in major cardiovascular events and stroke with candesartan-based therapy were indicated in all subgroups. A significant interaction between treatment and subgroups was found for one pair of subgroups only; the reduction in major cardiovascular events with candesartan was greater in patients with a previous stroke (64% reduction, p = 0.004) than in those without (5% reduction, p > 0.20). In conclusion, this analysis indicated consistent favourable effects of candesartan-based therapy on major cardiovascular events and stroke across the different subgroups of patients. However, the benefit was particularly pronounced in patients who entered the study with a previous stroke.
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