Stroke is the leading cause of death in China, and it is the second leading cause of death worldwide. In the past, interventions focused on secondary preventive measures. So far, this has not become a major concern because evidence suggests that if a patient suffers the first stroke, they remain vulnerable to further events. Preventing the existence of the first incident is thereby important. Insufficient and inconsistent data on the efficacy of folic acid for primary prevention inspired this clinical trial which worked on how to prevent the first instance of stroke among hypertensive adults. They gave folic acid alongside Elanapril as medication to Chinese adults with hypertension to compare its efficacy with Elanapril alone in reducing first events of stroke. Their results showed that in the four and a half years of medication and follow-up, the group that received elanapril and folic acid had a greater reduction in the occurrence of the first stroke with only 2.7% of the patients suffering first stroke against 3.4% in the group receiving elanapril alone. Other secondary outcomes observed including first myocardial infarction, first hemorrhagic and ischemic stroke and cardiovascular events that may cause death did not have significant differences between the two groups (Huo et al. 1330).
Terms Meaning from Merriam-Webster Medical Dictionary
Polymorphism (p.1326) Existence of a gene in several alleles
Ceiling effect (p.1332) Complete effectiveness of a medication such that increasing dosage would be meaningless
Concomitant use (p. 1333) Using together with
This clinical trial acknowledges the role of hypertension as a risk factor for stroke (Huo et al. 1333). It, therefore, studies folic acid as a preventive measure for stroke. Folic acid metabolism is regulated by methylenetetrahydrofolate reductase (MTHFR). Mutation in the C677T region of the MTHFR gene reduces enzyme activity and subsequently, the folic acid levels in the body. Therefore, the risk of developing stroke from a genetic point of view is correlated to the variant of the MTHFR gene presents and its relative influence on the folate status.
They also consider that studies on secondary prevention that dismissed the importance of folic acid were carried out in areas where grains were fortified with folic acid and therefore the beneficial effect could not be directly identified (Huo et al. 1326).
The purpose of this study dubbed as CSPPT, the China Stroke Primary Prevention Trial was to investigate the effectiveness of enalaprilfolic acid therapy against enalapril alone in the prevention of the first stroke among hypertensive Chinese adults.
The participants qualified for the study were men and women between 45-75 years. They ought to have been clinically diagnosed with hypertension. During screening the systolic blood pressure should exceed 140mmHG while the diastolic should be higher than 90mmHG. Those with a history of stroke, heart failure or congenital conditions and myocardial infarction were excluded. Genotyping was then done to check on MTHFR C677T polymorphisms. The qualified subjects were put on a three-week oral dose of enalapril 10 mg daily. Those who shoed goof tolerance were and had TT, CT or CC genotypes in the MTHFRC677T were randomly assigned to study treatments. The experimental group were the subjects taking the enalapril-folic acid therapy while the control group was composed of those under enalapril alone (Huo et al. 1326).
This clinical trial is so relevant because it touches on a current issue in public health. Its strategy is also a novel idea at a primary research level and therefore provides a potential solution to stroke prevention. It gives an in-depth description of the steps undertaken. Also, its findings validate the efficacy of folic acid as a stroke prevention remedy.
Huo, Yong et al. Efficacy of Folic Acid Therapy in Primary Prevention of Stroke Among Adults With Hypertension in China. JAMA 313.13 (2015): 13251335. Web.
Merriam-Webster Medical Dictionary.Web. 4 Dec. 2017 from c.merriam-webster.com/medlineplus/