Add-on folic acid treatment confers stroke-free survival gains in hypertensive patients

The use of folic acid in addition to enalapril in the treatment of patients with hypertension yields a modest increase in lifetime stroke-free survival, a study has found.

Add-on folic acid therapy has been previously shown to be more effective than enalapril monotherapy at reducing the risk of first stroke in hypertensive patients enrolled in the China Stroke Primary Prevention Trial (CSPPT).

In the current analysis, researchers used data from 19,053 participants (mean age, 60.8 years; 41.1 percent male) of the CSPPT and established adjusted models for competing risks and an age-based time scale to estimate lifetime incremental stroke-free survival for the enalapril–folic acid combo vs enalapril alone.

In the cohort, 23.7 percent of patients were actively smoking and 24.0 percent consumed alcohol. The respective mean systolic and diastolic blood pressure levels were 167.2 and 93.7 mm Hg at baseline and 139.4 and 82.6 mm Hg during treatment.

Projected median lifetime stroke-free survival was longer by 1.75 months (interquartile range, 0.73–2.39) with the combination of enalapril plus folic acid treatment vs enalapril alone. The maximum survival gain was up to 12.95 months.

Subgroup analyses showed that the beneficial effect of the enalapril–folic acid combo on stroke-free survival was greater in patients who were younger, male, with lower baseline folate levels, higher baseline systolic blood pressure, higher baseline total cholesterol and blood glucose, and with MTHFR (methylenetetrahydrofolate reductase) C677T CT or TT genotype.

The study suggests that even a moderate gain may translate into a gain of millions of stroke-free months, according to the researchers. This finding should help clinicians and patients to make informed decisions on stroke prevention.