The China Stroke Primary Prevention Trial was a double-blinded RCT of approximately 20,000 hypertensive patients in China with no previous history of a stroke. The aim was to see if patients taking enalapril (10mg) and folic acid (0.8mg) had a lower risk of stroke than patients on enalapril alone.
1 Patients on folic acid and enalapril had a 21% lower risk of stroke compared with patients on enalapril alone.
2 Patients on folic acid and enalapril also had a 20% lower rate of cardiovascular events overall, including heart attack, stroke and cardiovascular death, compared with patients on enalapril alone.
3 The risk of hemorrhagic stroke was not significantly different between the two groups.
What does this mean for GPs?
Treating folic acid deficiency helps reduce the risk of stroke.
Detecting and diagnosing folic acid deficiency is especially important in hypertensive patients and others at risk of stroke.
Dr Hamed Khan is a GP in the emergency department of St George’s, London and a clinical lecturer. He tweets as @drhamedkhan