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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

References

    1. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459–1544. - PMC - PubMed
    1. He J, Gu D, Chen J, Wu X, Kelly TN, Huang JF, et al. Premature deaths attributable to blood pressure in China: a prospective cohort study. Lancet. 2009;374(9703):1765–72. - PubMed
    1. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people. Lancet. 2014;383(9932):1899–911. - PMC - PubMed
    1. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387(10022):957–67. - PubMed
    1. Bundy JD, Li C, Stuchlik P, Bu X, Kelly TN, Mills KT, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol. 2017;2(7):775–781. - PMC - PubMed

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