• William J He, Chongke Zhong, Tan Xu, Dali Wang, Yingxian Sun, Xiaoqing Bu, Chung-Shiuan Chen, Jinchao Wang, Zhong Ju, Qunwei Li, Jintao Zhang, Deqin Geng, Jianhui Zhang, Dong Li, Yongqiu Li, Xiaodong Yuan, Yonghong Zhang, Tanika N Kelly, and CATIS investigators.
• Department of Epidemiology, School of Public Health and Tropical Medicine.
• J. Hypertens. 2018 Jun 1; 36 (6): 1372-1381.

BackgroundWe studied the effect of early antihypertensive treatment on death, major disability, and vascular events among patients with acute ischemic stroke according to their baseline SBP.MethodsWe randomly assigned 4071 acute ischemic stroke patients with SBP between 140 and less than 220 mmHg to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. A composite primary outcome of death and major disability and secondary outcomes were compared between treatment and control stratified by baseline SBP levels of less than 160, 160-179, and at least 180 mmHg.ResultsAt 24 h after randomization, differences in SBP reductions were 8.8, 8.6 and 7.8 mmHg between the antihypertensive treatment and control groups among patients with baseline SBP less than 160, 160-179, and at least 180 mmHg, respectively (P < 0.001 among subgroups). At day 14 or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups among subgroups. However, there was a significant interaction between antihypertensive treatment and baseline SBP subgroups on death (P = 0.02): odds ratio (95% CI) of 2.42 (0.74-7.89) in patients with baseline SBP less than 60 mmHg and 0.34 (0.11-1.09) in those with baseline SBP at least 180 mmHg. At the 3-month follow-up, the primary and secondary clinical outcomes were not significantly different between the treatment and control groups by baseline SBP levels.ConclusionEarly antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with various baseline SBP levels. Future clinical trials are warranted to test BP-lowering effects in acute ischemic stroke patients by baseline SBP levels.Trial RegistrationClinicalTrials.gov Identifier: NCT01840072.

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