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The article focuses on a study which assessed the long-term effects of successful carotid endarterectomy (CEA) in patients with asymptomatic stenosis. The study included 3,120 asymptomatic patients from 126 centers in 30 countries, who were randomized to receive either immediate CEA or indefinite deferral of any carotid procedure. Study authors concluded that successful CEA reduced 10-year stroke risks in asymptomatic patients who are younger than 75 years.

Summary Background Results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) show significantly lower rates of coronary and stroke events in individuals allocated an amlodipine-based combination drug regimen than in those allocated an atenolol-based combination drug regimen (HR 0·86 and 0·77, respectively). Our aim was to assess to what extent these differences were due to significant differences in blood pressures and in other variables noted after randomisation. Methods We used data from ASCOT-BPLA (n=19 257) and compared differences in accumulated mean blood pressure levels at sequential times in the trial with sequential differences in coronary and stroke events. Serial mean matching for differences in systolic blood pressure was used to adjust HRs for differences in these events. We used an updated Cox-regression model to assess the effects of differences in accumulated mean levels of various measures of blood pressure, serum HDL-cholesterol, triglycerides and potassium, fasting blood glucose, heart rate, and bodyweight on differences in event rates. Findings We noted no temporal link between size of differences in blood pressure and different event rates. Serial mean matching for differences in systolic blood-pressure attenuated HRs for coronary and stroke events to a similar extent as did adjustments for systolic blood-pressure differences in Cox-regression analyses. HRs for coronary events and stroke adjusted for blood pressure rose from 0·86 (0·77-0·96) to 0·88 (0·79-0·98) and from 0·77 (0·66-0·89) to 0·83 (0·72-0·96), respectively. Multivariate adjustment gave HRs of 0·94 (0·81-1·08) for coronary events (HDL cholesterol being the largest contributor) and 0·87 (0·73-1·05) for stroke events. Interpretation Multivariate adjustment accounted for about half of the differences in coronary events and for about 40% of the differences in stroke events between the treatment regimens tested in ASCOT-BPLA, but residual differences were no longer significant. These residual differences could indicate inadequate statistical adjustment, but it remains possible that differential effects of the two treatment regimens on other variables also contributed to the different rates noted, particularly for stroke. [ABSTRACT FROM AUTHOR]

The author examines the clinical implications of data from three studies which discovered an excess risk of stroke and death posed by angioplasty and stenting. He presents an overview of the studies, which included the International Carotid Stenting Study and the Carotid Revascularization Endarterectomy Versus Stent Trial. He cites several reasons for the difficulty of justifying routine stenting in symptomatic patients. The author also describes the advantages of endarterectomy over stenting.

A letter to the editor is presented in response the article "Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis," by Alastair Webb and colleagues, published in the March 13, 2010 issue, along with a response of the research authors.

Reports patients who stop taking their antihypertensive drugs are at an increased risk of stroke. Amanda Thrift and coworkers in Australia finding intracerebral hemorrhage associated with hypertension was higher in patients who stopped medication; The question of why patients stop taking medications for treatment of high blood pressure.