gms | German Medical Science

27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga

Deutsche Liga zur Bekämpfung des hohen Blutdrucks – Deutsche Hypertonie Gesellschaft e. V.

26. bis 29.11.2003, Bonn

Blood-pressure rhythm in acute cerebral ischemia : Analyses from the ACCESS-Study: Acute Candesartan Cilexetil Evaluation in Stroke Survivors

Blutdruckrhythmus bei akuter cerebraler Ischämie: Analysen aus der ACCESS-Studie

Meeting Abstract (Hypertonie 2003)

  • presenting/speaker A. Kulschewski - St. Josefs-Hospital Cloppenburg
  • S. Lüders - St. Josefs-Hospital Cloppenburg
  • U. Venneklaas - St. Josefs-Hospital Cloppenburg
  • J. Schrader - St. Josefs-Hospital Cloppenburg

Hypertonie 2003. 27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Bonn, 26.-29.11.2003. Düsseldorf, Köln: German Medical Science; 2004. Doc03hochV48

The electronic version of this article is the complete one and can be found online at:

Published: November 11, 2004

© 2004 Kulschewski et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



The ACCESS study assessed the safety of modest blood pressure (BP) reduction by candesartan cilexetil (cc) in the treatment of acute stroke.


Patients (pts) with acute cerebral ischemia (CI) and neurological deficit were randomized in case of hypertension. Pts were treated double-blind for 7 days with placebo (pl) or cc. On the 7th day all pts got an ABPM according to which all hypertensive pts from both groups were treated with cc. In case of normotension pts were only followed-up. A combination therapy was possible. Follow-up period: 12 months.

Primary endpoints were the pts morbidity rate (cardio- and cerebrovascular events) and total mortality after 3 months. Analyses of ABPM, BP levels at hospitalization and their correlation to the prognosis will be presented.


More than 2/3 of pts with acute CI were non-dipper (nd) in ABPM 7 days and 3 months after onset of symptoms. The rate of pts with inverse rhythm was 4.8 % on day 7 and 3.8 % after 3 months. In the group of pts having BP values >= 200 mmHg systolic (sys) at hospitalization we found more endpoints than among those showing BP values < 200 mmHg sys (17.4 % vs 10.9%) while there were no differences in sex, age, BMI, concomitant diseases and risk factors. A significant higher rate of primary events (15.2% vs 4.4%, p=0.09) was found for nd in ABPM after 7 days when these pts showed BP values >= 200 mmHg sys at hospitalization.


A blood pressure >= 200 mmHg at hospitalization and non-dipping in ABPM after 7 days were associated with a poorer prognosis on pts outcome.