Effects of telmisartan on the cerebral circulation of hypertensive patients with chronic-stage stroke.

This prospective study examined the effects of telmisartan, an angiotensin II type I receptor blocker with peroxisome proliferator-activated receptor gamma agonistic action, on blood pressure (BP) control and cerebral circulation in hypertensive patients with chronic-stage stroke. Telmisartan (40 mg per day) was administered to 10 patients with systolic BP (SBP) 140 mm Hg and diastolic BP (DBP) 90 mm Hg at least 4 weeks after lacunar or atherothrombotic infarction. Casual BP and resting cerebral blood flow (CBF) were evaluated at baseline and week 12 using technetium-99 m ethyl cysteinate dimer single-photon emission computed tomography. Both SBP and DBP declined significantly from 156.4±17.0 to 127.4±6.6 mm Hg and 84.2±14.5 to 74.2±5.2 mm Hg, respectively (P<0.05). Mean CBF (mCBF) in both the left and right cerebral hemispheres did not change, and the mCBF of both the impaired and unimpaired sides of supratentorial lesion patients (n=6) did not change. Investigation of regional CBF in all patients revealed significant increases in the callosomarginal, precentral, central, parietal, temporal, posterior cerebral, lenticular nucleus, thalamic and hippocampal regions at week 12 (P<0.05). Telmisartan showed good antihypertensive activity in hypertensive patients with chronic-stage stroke without affecting hemispheric blood flow, and it even increased regional CBF in most regions examined.