Morbidity and mortality after stroke in patients with diabetes - Subgroup analysis from the MOSES-Study

Journal of Clinical and Basic Cardiology 2006; 9 (Sonderheft 1): 2-5

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Keywords: Diabetes mellitus,  Eprosartan,  Hypertonie,  Prävention,  Schlaganfall,  hypertension,  nitrendipine,  stroke prevention

Background: The MOSES study was the first one to show significant advantages in the treatment with eprosartan in contrast to nitrendipine in the secondary prevention of hypertensive stroke patients. In prespecified analyses, we compared the effects of antihypertensive treatment with eprosartan and nitrendipine on cerebro- and cardiovascular morbidity and mortality. Methods: As part of the MOSES study carried out in accordance with the PROBE design (prospective, randomised, open-label, blinded endpoint) we assigned a group of 498 hypertensive stroke patients with diabetes on eprosartan or nitrendipine based treatment with regard to cerebro- and cardiovascular events. Primary endpoint included all deaths and all recurrent cerebro- and cardiovascular events. Results: There were no relevant differences in the basic demographic data between eprosartan and nitrendipine based therapy. Initial similar blood pressure values (150.7/85.2 mmHg versus 152.3/86.1 mmHg) turned into higher systolic and diastolic ones in the eprosartan group after 3 months and even reached statistical significance after 12 months (140.3/80.4 mmHg versus 135.9/78.5 mmHg) and 36 months (140.1/82.4 mmHg versus 134.9/78.8 mmHg). While primary endpoints, cerebro- and cardiovascular events showed no significant difference between eprosartan and nitrendipine based therapy groups, in contrast they were all significantly more frequent (p = 0.001) in the diabetic patients compared to the non-diabetic group. Conclusion: There was no difference in the event rate between both groups, although blood pressure reduction was significantly higher in nitrendipine than eprosartan based therapy. This lacking difference is due to different blood pressure reduction. This underlies the outstanding importance of blood pressure reduction in high-risk patients towards beyond blood pressure lowering effects of antihypertensive drugs.