Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial.

What this study found

Enalapril plus folic acid reduced first stroke compared with enalapril alone. The primary outcome occurred in 282 participants (2.7%) versus 355 (3.4%), with HR 0.79 (95% CI, 0.68-0.93; P = .003). Ischemic stroke was also lower with the combination, 223 (2.2%) versus 292 (2.8%), HR 0.76 (95% CI, 0.64-0.91; P = .002), and the composite of stroke, myocardial infarction, or cardiovascular death was reduced, 324 (3.1%) versus 405 (3.9%), HR 0.80 (95% CI, 0.69-0.92; P = .002). There were no significant differences for hemorrhagic stroke, myocardial infarction, cardiovascular death, or all-cause…

Study & population

Randomized clinical trial in Chinese adults with hypertension aged 45-75 years, with no prior stroke or myocardial infarction, enrolled from 32 communities in Jiangsu and Anhui provinces.

Intervention

In the enalapril-folic acid group, participants received 1 oral tablet daily containing 10 mg of enalapril and 0.8 mg of folic acid for 5 years.

Key limitation

The active regimen combined folic acid with enalapril, so the findings support the addition of folic acid to standard therapy rather than folic acid alone.

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