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- Title
2015 - In Chinese adults with hypertension, adding folic acid to enalapril reduced incident stroke.
- Authors
Barer, David
- Abstract
Question In Chinese adults with hypertension, does enalapril plus folic acid reduce incident stroke more than enalapril alone? Methods Design Randomized controlled trial (China Stroke Primary Prevention Trial [CSPPT]). ClinicalTrials.gov NCT00794885. Trial was stopped early for efficacy. Allocation Concealed.* Blinding Blinded* (patients, investigators, outcome and data assessors, monitoring committee). Follow-up period Median 4.5 years. Setting 32 communities in Jiangsu and Anhui provinces, China. Patients 20 702 patients 45 to 75 years of age (mean age 60 y, 59% women) who had hypertension (seated resting systolic blood pressure [BP] ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg at screening and recruitment visits or were receiving antihypertensive medication) and good adherence to oral enalapril, 10 mg/d, during a 3-week run-in phase. Exclusion criteria included previous stroke, myocardial infarction (MI), heart failure, coronary revascularization, or congenital heart disease. Intervention Combination pill of oral enalapril, 10 mg/d, plus folic acid, 0.8 mg (n = 10 348), or oral enalapril, 10 mg/d, alone (n = 10 354). Concomitant use of other antihypertensive drugs (except B vitamins) was permitted. Outcomes Primary outcome was first stroke (fatal or nonfatal, ischemic or hemorrhagic). Secondary outcomes included a composite of cardiovascular (CV) events (stroke, CV death, or MI), components of the composite outcome, and all-cause death. Patient follow-up 99.7% (intention-to-treat analysis). Main results The main results are in the Table. Conclusion In Chinese adults with hypertension, enalapril plus folic acid reduced incident stroke more than enalapril alone.
- Subjects
CHINA; EUROPE; UNITED States; CARDIOVASCULAR disease related mortality; STROKE prevention; FOLIC acid metabolism; ENRICHED foods; BLOOD pressure; CHINESE people; COMBINED modality therapy; CONFIDENCE intervals; DIETARY supplements; DRUGS; FOLIC acid; FOLIC acid deficiency; GENES; HYPERTENSION; LONGITUDINAL method; MORTALITY; MYOCARDIAL infarction; PATIENT compliance; STROKE; RANDOMIZED controlled trials; RELATIVE medical risk; TREATMENT effectiveness; ENALAPRIL; GENOTYPES; DISEASE complications
- Publication
ACP Journal Club, 2015, Vol 163, Issue 2, p7
- ISSN
1056-8751
- Publication type
Article