Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial.
OBJECTIVE
Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain.


OBJECTIVE
To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge.


METHODS
The China Antihypertensive Trial in Acute Ischemic Stroke, a single-blind, blinded end-points randomized clinical trial, conducted among 4071 patients with nonthrombolysed ischemic stroke within 48 hours of onset and elevated systolic blood pressure. Patients were recruited from 26 hospitals across China between August 2009 and May 2013.


METHODS
Patients (n = 2038) were randomly assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10% to 25% within the first 24 hours after randomization, achieving blood pressure less than 140/90 mm Hg within 7 days, and maintaining this level during hospitalization) or to discontinue all antihypertensive medications (control) during hospitalization (n = 2033).


METHODS
Primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at 14 days or hospital discharge.


RESULTS
Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg (-12.7%) within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg (-7.2%) in the control group within 24 hours after randomization (difference, -5.5% [95% CI, -4.9 to -6.1%]; absolute difference, -9.1 mm Hg [95% CI, -10.2 to -8.1]; P < .001). Mean systolic blood pressure was 137.3 mm Hg in the antihypertensive treatment group and 146.5 mm Hg in the control group at day 7 after randomization (difference, -9.3 mm Hg [95% CI, -10.1 to -8.4]; P < .001). The primary outcome did not differ between treatment groups (683 events [antihypertensive treatment] vs 681 events [control]; odds ratio, 1.00 [95% CI, 0.88 to 1.14]; P = .98) at 14 days or hospital discharge. The secondary composite outcome of death and major disability at 3-month posttreatment follow-up did not differ between treatment groups (500 events [antihypertensive treatment] vs 502 events [control]; odds ratio, 0.99 [95% CI, 0.86 to 1.15]; P = .93).


CONCLUSIONS
Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge.


BACKGROUND
clinicaltrials.gov Identifier: NCT01840072.
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China2Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana3Department of Medicine, Tulane Un.
Jiang
J
He
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China2Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Yonghong
Y
Zhang
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.
Tan
T
Xu
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Qi
Q
Zhao
Department of Neurology, Affiliated Hospital of Hebei United University, Hebei, China.
Dali
D
Wang
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
Chung-Shiuan
CS
Chen
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.
Weijun
W
Tong
Department of Neurology, Yutian County Hospital, Hebei, China.
Changjie
C
Liu
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.
Tian
T
Xu
Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China.
Zhong
Z
Ju
Department of Neurology, Affiliated Hospital of Hebei United University, Hebei, China.
Yanbo
Y
Peng
Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.
Hao
H
Peng
Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China.
Qunwei
Q
Li
Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Jiangsu, China.
Deqin
D
Geng
Department of Neurology, the 88th Hospital of PLA, Shandong, China.
Jintao
J
Zhang
Department of Internal Medicine, Feicheng City People's Hospital, Shandong, China.
Dong
D
Li
Department of Neurology, Tongliao Municipal Hospital, Inner Mongolia, China.
Fengshan
F
Zhang
Department of Neurology, Siping Central Hospital, Jilin, China.
Libing
L
Guo
Department of Cardiology, the First Affiliated Hospital of China Medical University, Liaoning, China.
Yingxian
Y
Sun
Department of Neurology, Jilin Central Hospital, Jilin, China.
Xuemei
X
Wang
Department of Neurology, General Hospital of First Automobile Works, Jilin, China.
Yong
Y
Cui
Department of Neurology, Tangshan Worker's Hospital, Hebei, China.
Yongqiu
Y
Li
Department of Neurology, the First Affiliated Hospital of Jilin University, Jilin, China.
Dihui
D
Ma
Department of Neurology, the Second People's Hospital of Huaian City, Jiangsu, China.
Guang
G
Yang
Department of Neurology, Affiliated Hospital of Chengde Medical College, Hebei, China.
Yanjun
Y
Gao
Department of Neurology, Kailuan General Hospital, Hebei, China.
Xiaodong
X
Yuan
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana3Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana4Tulane Hypertension and Renal Center of Excellence, Ne.
Lydia A
LA
Bazzano
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana3Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana4Tulane Hypertension and Renal Center of Excellence, Ne.
Jing
J
Chen
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents