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Randomized Controlled Trial
. 2018 Jun;36(6):1372-1381.
doi: 10.1097/HJH.0000000000001690.

Early antihypertensive treatment and clinical outcomes in acute ischemic stroke: subgroup analysis by baseline blood pressure

William J He  1   2 , Chongke Zhong  1   3 , Tan Xu  3 , Dali Wang  4 , Yingxian Sun  5 , Xiaoqing Bu  3 , Chung-Shiuan Chen  1 , Jinchao Wang  6 , Zhong Ju  7 , Qunwei Li  8 , Jintao Zhang  9 , Deqin Geng  10 , Jianhui Zhang  11 , Dong Li  12 , Yongqiu Li  13 , Xiaodong Yuan  14 , Yonghong Zhang  3 , Tanika N Kelly  1 ; CATIS investigators
Affiliations
Randomized Controlled Trial

Early antihypertensive treatment and clinical outcomes in acute ischemic stroke: subgroup analysis by baseline blood pressure

William J He et al. J Hypertens. 2018 Jun.

Abstract

Background: We studied the effect of early antihypertensive treatment on death, major disability, and vascular events among patients with acute ischemic stroke according to their baseline SBP.

Methods: We randomly assigned 4071 acute ischemic stroke patients with SBP between 140 and less than 220 mmHg to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. A composite primary outcome of death and major disability and secondary outcomes were compared between treatment and control stratified by baseline SBP levels of less than 160, 160-179, and at least 180 mmHg.

Results: At 24 h after randomization, differences in SBP reductions were 8.8, 8.6 and 7.8 mmHg between the antihypertensive treatment and control groups among patients with baseline SBP less than 160, 160-179, and at least 180 mmHg, respectively (P < 0.001 among subgroups). At day 14 or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups among subgroups. However, there was a significant interaction between antihypertensive treatment and baseline SBP subgroups on death (P = 0.02): odds ratio (95% CI) of 2.42 (0.74-7.89) in patients with baseline SBP less than 60 mmHg and 0.34 (0.11-1.09) in those with baseline SBP at least 180 mmHg. At the 3-month follow-up, the primary and secondary clinical outcomes were not significantly different between the treatment and control groups by baseline SBP levels.

Conclusion: Early antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with various baseline SBP levels. Future clinical trials are warranted to test BP-lowering effects in acute ischemic stroke patients by baseline SBP levels.

Trial registration: ClinicalTrials.gov Identifier: NCT01840072.

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Conflict of interest statement

Conflicts of interest

None.

Figures

Figure 1.
Figure 1.
Flow chart of trial participants.
Figure 2.
Figure 2.
Mean and 95% confidence interval of systolic BP since randomization by treatment group. Upper panel: subgroup with baseline systolic BP <160 mmHg; middle panel: baseline systolic BP 160-179 mmHg; and lower panel: baseline systolic BP ≥180 mmHg.
See this image and copyright information in PMC

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