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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60:463-465 (2005)
© 2005 The Gerontological Society of America

Treatment With Angiotensin-Converting Enzyme Inhibitors Is Associated With a Reduction in Short-Term Mortality in Older Patients With Acute Ischemic Stroke

Giovanni Zuliani1,, Antonio Cherubini2, Stefano Volpato1, Anna Rita Atti1, Alessandro Blè1, Chella Vavalle1, Filippo Di Todaro1, Claudia Benedetti2, Carmelinda Ruggiero2, Umberto Senin2 and Renato Fellin1

1 Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology & Geriatrics, University of Ferrara, Italy.
2 Institute of Gerontology & Geriatrics, University of Perugia, Italy.

Address correspondence to Giovanni Zuliani, MD, PhD, Dipartimento di Medicina Clinica & Sperimentale, Sezione di Medicina Interna, Gerontologia & Geriatria, Universitá degli Studi, via Savonarola n°9, 44100 Ferrara, Italy. E-mail: gzuliani{at}

Background. Stroke is the third cause of death in older people living in Western countries. We tested the hypothesis that angiotensin-converting enzyme inhibitors (A-I) might affect short-term (30 day) mortality in older persons with severe acute ischemic stroke.

Methods. We analyzed data from a retrospective study including 475 consecutive older patients hospitalized for acute ischemic stroke. Mean age was 78.4 ± 9.2 years; 58.2% were female. Stroke type was classified according to the Oxford Community Stroke Project (OCSP).

Results. Mortality rate was 28%. Thirty-two percent of patients were treated with A-I; mortality was 16.5% in patients treated compared with 33.3% in those not treated ({chi}2 p =.001). The odds ratio for mortality in treated patients was: 0.47 (0.25–0.89) after full adjustment (age, sex, mean diastolic and systolic blood pressure, previous stroke and/or transient ischemic attack, congestive heart failure, atrial fibrillation, diabetes, hypertension, coronary heart disease, and previous treatment with A-I); 0.29 (0.09–0.89) in patients with altered level of consciousness after full adjustment; 0.60 (0.33–1.12) after adjustment for OCSP classification, age, and sex; and 0.30 (0.08–0.97) in total anterior circulation infarction stroke type after full adjustment.

Conclusions. Our data suggest that treatment with A-I might reduce short-term mortality in older patients with acute ischemic stroke. Randomized clinical trials should confirm this possible specific effect of A-I.

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