Antihypertensive therapy given during the acute phase of ischemic stroke does not reduce the short-term risk of death or dependency, according to results of the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) trial presented Nov. 17 as part of AHA 2013, and published simultaneously in the Journal of the American Medical Association.

The trial enrolled 4,071 patients from 26 hospitals across China with a computed tomography- or cardiac magnetic resonance imaging-confirmed ischemic stroke who had a systolic blood pressure (BP) between ≥140 and <220 mm Hg. Patients were randomized to acute antihypertensive therapy given within 48 hours of stroke onset compared with no antihypertensive therapy.

In the acute hypertension treatment group, mean systolic BP was reduced from 166.7 mm Hg at baseline to 144.7 mm Hg and 135.2 mm Hg at 24 hours and 14 days, respectively. In the control arm, mean systolic BP values were 165.6, 152.9 and 143.7 mm Hg at baseline, 24 hours and 14 days, respectively (p<0.0001 for differences in BP reduction). At 14 days, the incidence of the primary composite endpoint of death and dependency – defined as a modified Rankin score [mRS] ≥3 – was 33.6 percent in the treatment group and 33.6 percent in the control group (p=0.98). At three months, 25.2 percent and 25.3 percent of patients in the intervention and control arms, respectively, reached the secondary endpoint of death, dependency and vascular events (p=0.93).

"Among patients with acute ischemic stroke, BP reduction with antihypertensive medications compared with the absence of antihypertensive medications did not reduce death and major disability at 14 days or hospital discharge," said the investigators. "These findings suggest that unless a patient's BP is ≥220/120 mm Hg, the decision to lower BP with antihypertensive treatment in patients with acute ischemic stroke should be based on individual clinical judgment."

Keywords: Incidence, Risk, Stroke, China, Tomography, Blood Pressure, Magnetic Resonance Imaging, Hypertension, Systole