Blood pressure reduction in acute ischemic stroke according to time to treatment: a subgroup analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial.
The optimal time to initiate antihypertensive therapy among patients with acute ischemic stroke remains uncertain. We tested the effects of blood pressure reduction among patients with acute ischemic stroke according to time from onset to initiation of antihypertensive treatment.



We randomly assigned 4071 acute ischemic stroke patients with elevated SBP to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. The primary outcome was a combination of death and major disability, and secondary outcomes included the modified Rankin score, recurrent stroke, vascular disease events, and all-cause mortality.



At 24 h after randomization, the differences in SBP reductions were 8.7, 9.5, and 9.6 mmHg between the antihypertensive treatment and control groups among patients receiving treatment within less than 12, 12-23, and 24-48 h after stroke onset, respectively (P < 0.001 in all subgroups). At day 14 or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups in all subgroups. At the 3-month follow-up, death or major disability [odds ratio (OR) 0.73; 95% confidence interval (CI) 0.55-0.96; P = 0.03], recurrent stroke (OR 0.25; 95% CI 0.08-0.74; P = 0.01), and vascular events (OR 0.41; 95% CI 0.18-0.95; P = 0.04) were significantly reduced in the antihypertensive treatment group only among participants who received treatment between 24 and 48 h.



Blood pressure reduction might reduce 3-month death and major disability and recurrent stroke among patients with acute ischemic stroke who receive antihypertensive treatment between 24 and 48 h after stroke onset.



ClinicalTrials.gov Identifier: NCT01840072.
aSchool of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China bTulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA cAffiliated Hospital of Hebei United University, Shijiazhuang, Hebei dFirst Affiliated Hospital of China Medical University, Shenyang, Liaoning eYutian County Hospital, Tangshan, Hebei fKerqin District First People's Hospital of Tongliao City, Tongliao, Inner Mongolia gAffiliated Hospital of Nantong University, Nantong, Jiangsu hSchool of Public Health, Taishan Medical College, Tai'an, Shandong iAffiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu jThe 88th Hospital of PLA kFeicheng City People's Hospital, Tai'an, Shandong lTongliao Municipal Hospital, Tongliao, Inner Mongolia mSiping Central Hospital, Siping nJilin Central Hospital, Jilin City oGeneral Hospital of First Automobile Works, Changchun, Jilin pTangshan Worker's Hospital, Tangshan, Hebei qFirst Affiliated Hospital of Jilin University, Changchun, Jilin rDongping County People's Hospital, Tai'an, Shandong sSecond People's Hospital of Huaian City, Huai'an, Jiangsu tAffiliated Hospital of Chengde Medical College, Chengde, Hebei uKailuan General Hospital, Tangshan, Hebei, China vTulane University School of Medicine, New Orleans, Louisiana, USA.
Tan
T
Xu
Yonghong
Y
Zhang
Xiaoqing
X
Bu
Dali
D
Wang
Yingxian
Y
Sun
Chung-Shiuan
CS
Chen
Jinchao
J
Wang
Hao
H
Peng
Zhong
Z
Ju
Yanbo
Y
Peng
Tian
T
Xu
Qunwei
Q
Li
Deqin
D
Geng
Jintao
J
Zhang
Dong
D
Li
Fengshan
F
Zhang
Libing
L
Guo
Xuemei
X
Wang
Yong
Y
Cui
Yongqiu
Y
Li
Dihui
D
Ma
Dongsheng
D
Zhang
Guang
G
Yang
Yanjun
Y
Gao
Xiaodong
X
Yuan
Jing
J
Chen
Jiang
J
He
D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D061665:Time-to-Treatment; D016896:Treatment Outcome
D000959:Antihypertensive Agents