HealthDay News — The combined use of enalapril and folic acid is linked with a reduce risk of first stroke in patients with hypertension, according to the results of a study published in the Journal of the American Medical Association.

Because 77% of strokes are first events, primary prevention is key, but “uncertainty remains about the efficacy of folic acid therapy for the primary prevention of stroke because of limited and inconsistent data,” noted Yong Huo, MD, of the Peking University First Hospital in Beijing, and colleagues.

To examine whether enalapril plus folic acid is more effective in reducing first stroke compared with enalapril alone, the investigators conducted a randomized trial involving 20,702 adult patients with hypertension without history or stroke or myocardial infarction (MI). The participants were randomized to receive a single pill combination containing enalapril and folic acid (n=10,348) or a tablet with enalapril alone (n=10,354).

The enalapril-folic acid group had a significant risk reduction in first stroke compared with the enalapril group alone (2.7% versus 3.4%; hazard ratio, 0.79) during a median treatment duration of 4.5 years. The enalapril-folic acid group also had reduced risk of first ischemic stroke (hazard ratio, 0.76) and composite cardiovascular events consisting of cardiovascular death, MI, and stroke (hazard ratio, 0.80). There were no significant between-group differences noted in the risk of hemorrhagic stroke, MI, and all-cause deaths.

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“This finding is consistent with a benefit from folate use among adults with hypertension and low baseline folate levels,” concluded the researchers.


  1. Huo Y et al. JAMA. 2015; doi:10.1001/jama.2015.2274