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Antihypertensives reduced mortality after stroke

Issue: April 2008

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NEW ORLEANS — Patients with stroke treated with antihypertensives lisinopril or labetalol had lower mortality after three months than patients who received placebo, according to study results.

The treatments used in the Control of Hypertension and Hypotension Immediately Post-Stroke (CHHIPS) pilot trial did not cause serious adverse effects or increase early stroke severity.

“BP reduction was not associated with a deterioration of neurological status,” John Potter, DM, a study researcher from the University of East Anglia, United Kingdom, said at the International Stroke Conference. “Active treatment didn’t appear to alter death and disability at two weeks. … Borderline reduction in 90-day mortality with active treatment was seen, however. This gives us a good feeling about going on to do a final phase-3 study using these data.”

Antihypertensives performed well

Researchers from the United Kingdom enrolled 179 patients, but some withdrew. They randomly assigned the remaining patients to labetalol (n=56), lisinopril (n=57) or placebo (n=59) for 14 days. They included patients who had ischemic or hemorrhagic strokes within the prior 36 hours and hypertension defined as >160 mm Hg systolic BP. Both the drug and placebo groups had a mean age of 74 years. In the treatment groups, 57% of patients were men, whereas men accounted for 53% of the placebo group.

Target BP (145 mm Hg to 155 mm Hg) occurred at 24 hours for 57% of patients assigned labetalol, 65% assigned lisinopril and 46% assigned placebo.

After two weeks, BP declines were significantly greater in patients assigned active treatment than in patients in the placebo group (31 mm Hg vs. 24 mm Hg).

Those in the placebo group were more likely to die (HR=2.2; 95% CI, 1.0-5.0).

Based on the study results, the researchers said lisinopril and labetalol may also reduce stroke deaths at three months but recommend a larger, definitive study to confirm this finding. – by Judith Rusk

For more information:

• Potter JF. Control of Hypertension and Hypotension Immediately Post-Stroke (CHHIPS) pilot trial. #LB2. Presented at: the International Stroke Conference; Feb. 20-22, 2008; New Orleans.