High blood pressure and cholesterol both increase the risk of stroke, but it is unknown if combining anti-hypertensive treatment with statins protects against a first stroke.
Researchers carried out a 2×2 factorial design study involving 12,705 people at risk of cardiovascular disease who were randomly assigned to daily antihypertensive treatment (fixed-dose candesartan 16mg + hydrochlorothiazide [HCTZ] 12.5mg) or placebo, and rosuvastatin 10mg or placebo.
Over a median follow-up of 5.6 years, they found that the risk of all stroke was reduced by 30% in those who took rosuvastatin alone, but the risk was not significantly reduced by candesartan/HCTZ alone, compared with placebo. Among those with the highest systolic blood pressure (>143.5 mmHg), candesartan/HCTZ reduced first stroke by 42%.
In those who took both drugs, the risk of first stroke was reduced by 44%, compared with placebo.
The team, who presented their results at the American Heart Association International Stroke Conference in Los Angeles on 25 January 2018, said the findings indicated that patients at moderate risk of cardiovascular disease, with no history of clinical disease, should be considered for the combined treatment
 Bosch J, Lonn E, Zhu J et al. First stroke reduced 44 percent by well tolerated medications. Stroke outcomes from the heart outcomes prevention evaluation 3 study. Presented at: AHA International Stroke Conference; 24–26th January 2018; Los Angeles, California. Abstract available here: http://stroke.ahajournals.org/content/49/Suppl_1/A104 (accessed February 2018).