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BP reduction with medication immediately after stroke did not reduce death, disability
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DALLAS — Lowering BP with antihypertensive therapy in patients with acute ischemic stroke did not improve or worsen outcomes, according to findings from the China Antihypertensive Trial in Acute Ischemic Stroke.
At AHA 2013, Jiang He, MD, PhD, of Tulane University School of Public Health and Tropical Medicine, and colleagues examined whether moderate BP lowering within the first 48 hours after onset of acute ischemic stroke would reduce death or major disability at 14 days or at hospital discharge.
The randomized controlled CATIS trial included 4,071 patients with ischemic stroke within 48 hours of symptom onset and elevated systolic BP. All patients were recruited from 26 hospitals in China from August 2009 to May 2013.
Half of the patients (n=2,038) were assigned antihypertensive treatment with the goal to lower systolic BP by 10% to 25% within the first 24 hours after randomization, achieving BP <140/90 mm Hg within 7 days and maintaining this level during hospitalization. The other half (n=2,033), which served as a control group, were assigned to discontinue all antihypertensive medications during hospitalization.
According to results presented, average systolic BP was reduced by 12.7% (166.7 to 144.7 mm Hg) within 24 hours of randomization in the antihypertensive group compared with 7.2% (165.6 to 152.9 mm Hg) in the control group (P<.001). Seven days after randomization, the average systolic BP was 137.3 mm Hg in the antihypertensive treatment group and 146.5 mm Hg in the control group (P<.001).
The primary outcome, a composite of death and major disability at 14 days or hospital discharge, occurred at a rate of 33.6% in both groups (antihypertensive treatment, 683 events; control, 681 events; OR=1.00; 95% CI, 0.88-1.14). The secondary composite endpoint of death and major disability at 3-month follow-up was also similar and occurred at a rate of 25% in each group (antihypertensive treatment, 500 events; control, 502 events; OR=0.99; 95% CI, 0.86-1.15).
“These findings suggest that unless a patient’s BP is greater than 220 mm Hg systolic/120 mm Hg diastolic, the decision to lower BP with antihypertensive treatment in patients with acute ischemic stroke should be based on individual clinical judgment,” He said at a press conference.
Cathy Sila, MD, an invited discussant, said these findings could be helpful for the treatment of a subset of patients with stroke because, while the trial was negative, the outcomes were identical and patients were not harmed by the treatment.
“My take on [the] data, if confirmed, is that this could substantially add to our clinical judgment, at least for a subset of patients with acute ischemic stroke, which are past [the] hyperacute phase, have mild stroke severity and no major vessel occlusion,” said Sila, of University Hospitals Case Medical Center, Cleveland. - by Katie Kalvaitis and Erik Swain
For more information:
He J. LBCT.01. Acute cardiovascular and cerebrovascular care. Presented at: the American Heart Association Scientific Sessions; Nov. 16-20, 2013; Dallas.
He J. JAMA. 2013;doi:10.1001/jama.2013.282543.
Disclosure: He and Sila report no relevant financial disclosures.