Why the study?
Whether mean arterial pressure and pulse pressure could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remained uncertain.
Does early anti-hypertensive treatment reduce death or major disability in acute ischaemic stroke patients with elevated SBP, regardless of mean arterial pressure and pulse pressure levels?
Does early anti-hypertensive treatment reduce death or major disability in acute ischaemic stroke patients with elevated SBP, regardless of mean arterial pressure and pulse pressure levels?
Early anti-hypertensive therapy does not affect the odds of major disability, mortality, or vascular events in acute ischaemic stroke patients, regardless of baseline mean arterial pressure or pulse pressure.
Answers are grounded in this paper and cite their sources.
Early antihypertensive effects after ischaemic stroke may differ by MAP/PP levels; leaves open whether these perfusion markers can guide therapy.
BACKGROUND: Whether mean arterial pressure (MAP) and pulse pressure (PP), two indicators of cerebral perfusion, could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain. Our study was to explore the impact of early anti-hypertensive intervention on adverse clinical outcomes following ischaemic stroke stratified by the levels of MAP and PP based on the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). METHODS: The trial randomised 4071 acute ischaemic stroke patients with elevated systolic blood pressure (SBP) to receive anti-hypertensive treatment (targeting a 10%-25% reduction in SBP during the 24 hours postrandomisation, reaching a BP level <140/90 mm Hg in 7 days, further keeping these levels throughout hospitalisation) or discontinue anti-hypertensive treatment during hospitalisation. The primary outcome was death or major disability at 14 days or hospital discharge. Study outcomes were analysed by comparing the BP-lowering intervention group and control group, stratified by tertiles of MAP or PP levels. RESULTS: No significant difference was observed in the primary outcome between the intervention and control groups across all MAP (p=0.69 for homogeneity) and PP (p=0.78 for homogeneity) categories. The corresponding odds ratios (95% CIs) were 1.08 (0.85-1.36), 0.92 (0.74-1.15) and 1.00 (0.81-1.25) for participants with low, intermediate, and high MAP and were 0.99 (0.79-1.25), 1.06 (0.84-1.34) and 0.95 (0.77-1.18) for participants in PP subgroups, respectively. Furthermore, early anti-hypertensive intervention was not associated with secondary outcomes (including neurological deterioration, recurrent stroke, vascular events and all-cause mortality) by MAP and PP (all p>0.05). CONCLUSIONS: Early anti-hypertensive therapy neither decreased nor increased the odds of major disability, mortality, recurrent stroke or vascular events in patients with acute ischaemic stroke regardless of different MAP and PP levels. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT01840072.
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Zhu et al. (2025) studied this question.
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