Early antihypertensive treatment increased functional dependency or death at 90 days vs delayed treatment in AIS patients with higher PP and lower MAP (aOR 1.85; 95% CI 1.21-2.85; P=0.005).
RCT (n=4,810)
randomized
Yes
Does early antihypertensive treatment improve functional dependency or death in acute ischemic stroke patients?
Early antihypertensive therapy may increase the risk of functional dependency or death at 90 days in acute ischemic stroke patients who have higher pulse pressure combined with lower mean arterial pressure.
Effect estimate: aOR 1.85 (95% CI 1.21-2.85)
Absolute Event Rate: 14.2% vs 8.1%
p-value: p=0.005
Abstract Background and aims Whether pulse pressure (PP) and mean arterial pressure (MAP), reflecting arterial stiffness and perfusion status respectively, could guide antihypertensive strategy selection following acute ischemic stroke (AIS) remains unclear. We aimed to evaluate the effect of early antihypertensive treatment on clinical outcomes in AIS patients, stratified by the levels of MAP and PP. Methods A secondary analysis of the China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2) trial was performed, which randomized 4810 AIS patients (within 24-48 hours of onset and elevated SBP) to immediate or delayed antihypertensive treatment on day 8. The primary outcome was functional dependency or death (modified Rankin Scale mRS score ≥3) at 90 days. Results Significant interaction between MAP and treatment assignment was detected for the primary outcome in the higher PP subgroup (P for interaction = 0.049), but not in the lower PP subgroup (P for interaction = 0.49). Compared with delayed treatment, early antihypertensive treatment significantly increased the risk of the primary outcome only in patients with higher PP combined with lower MAP (14.2% vs 8.1%; aOR 1.85, 95% CI 1.21-2.85; P=0.005). Similar trends were observed for death or major disability and the ordinal distribution of mRS scores (P for interaction = 0.02 and 0.005, respectively) at 14 days or hospital discharge. Conclusions Early antihypertensive therapy may be associated with an increased risk of functional dependency or death at 90 days among AIS patients with higher PP combined with lower MAP. Simultaneous consideration of PP and MAP may inform antihypertensive strategy selection after AIS. Conflict of interest Zilin Zhao.nothing to disclose; Yuesong Pan.nothing to disclose; Liping Liu. nothing to disclose
Zhao et al. (Fri,) conducted a rct in Acute ischemic stroke (n=4,810). Immediate antihypertensive treatment vs. Delayed antihypertensive treatment on day 8 was evaluated on Functional dependency or death (modified Rankin Scale [mRS] score ≥3) at 90 days (aOR 1.85, 95% CI 1.21-2.85, p=0.005). Early antihypertensive treatment increased functional dependency or death at 90 days vs delayed treatment in AIS patients with higher PP and lower MAP (aOR 1.85; 95% CI 1.21-2.85; P=0.005).