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Randomized Controlled Trial
. 2016 Dec;11(9):1009-1019.
doi: 10.1177/1747493016660094. Epub 2016 Jul 13.

Effects of early blood pressure reduction on cognitive function in patients with acute ischemic stroke

Xiaoqing Bu  1   2 , Yonghong Zhang  1 , Lydia A Bazzano  2 , Tan Xu  1 , Libing Guo  3 , Xuemei Wang  4 , Jintao Zhang  5 , Yong Cui  6 , Dong Li  7 , Fengshan Zhang  8 , Zhong Ju  9 , Tian Xu  1   2 , Chung-Shiuan Chen  2 , Jing Chen  2   10 , Jiang He  11   2   10
Affiliations
Randomized Controlled Trial

Effects of early blood pressure reduction on cognitive function in patients with acute ischemic stroke

Xiaoqing Bu et al. Int J Stroke. 2016 Dec.

Abstract

Background: The effect of early blood pressure reduction on cognitive function in patients with acute ischemic stroke remains unknown.

Aim: We tested whether antihypertensive treatment would reduce cognitive impairment in patients with acute ischemic stroke.

Methods: In the China Antihypertensive Trial in Acute Ischemic Stroke, patients with elevated blood pressure were randomly assigned to receive antihypertensive treatment or to discontinue all hypertensive medications within 48 h of onset. Cognitive function was measured by the Mini-Mental State Examination and Montreal Cognitive Assessment at 3 months after randomization in a subsample of 638 participants.

Results: Mean systolic blood pressure was reduced by 21.5 mmHg in the antihypertensive treatment group and 13.9 mmHg in the control group within 24 h after randomization (P < 0.001). Mean systolic blood pressure was 134.9 mmHg in the antihypertensive treatment group and 141.6 mmHg in the control group at day 14 after randomization (P < 0.001). Median Mini-Mental State Examination score was 26 and Montreal Cognitive Assessment score was 22 in both the antihypertensive treatment and control groups at 3 months. An Mini-Mental State Examination < 24 was present in 30.9% of patients in the antihypertensive treatment group compared with 29.7% in the control group (odds ratio = 1.06; 95% confidence interval 0.75-1.48; P = 0.75). Likewise, proportions of patients with Montreal Cognitive Assessment < 26 were similar between the antihypertensive treatment (70.6%) and control (70.7%) groups (odds ratio = 0.99; 95% confidence interval 0.70-1.40; P = 0.96).

Conclusions: These data indicated that early blood pressure reduction with antihypertensive medication in patients with acute ischemic stroke had no effect on cognitive impairment at 3 months.

Keywords: Acute ischemic stroke; antihypertensive therapy; clinical trial; cognitive functions.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1A.
Figure 1A.
Mean Systolic (a) and Diastolic (b) Blood Pressure Since Randomization, by Treatment Group.
Figure 1.
Figure 1.
Trial participant flow chart.
Figure 2.
Figure 2.
Effect of antihypertensive treatment on cognitive impairment at 3-month follow-up visit according to pre-specified subgroups. Data markers indicate point estimates (with the area of the square proportional to the number of events), error bars indicate 95% confidence intervals.
See this image and copyright information in PMC

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