Abstract P212: Blood pressure lowering and clinical outcomes in patients with acute ischemic stroke: China Antihypertensive Trial in Acute Ischemic Stroke (CATIS)
Introduction: Observational studies have reported that a decrease in blood pressure (BP) within the first several days after stroke onset was associated with poorer, better, or no difference in adverse clinical outcomes among patients with acute ischemic stroke.
Hypothesis: We investigated the association of immediate BP lowering in acute ischemic stroke patients with major clinical outcomes at 14 days or hospital discharge and at a 3 month follow-up visit.
Methods: CATIS is a randomized clinical trial conducted in 4,071 Chinese patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP). Patients were randomly assigned to receive antihypertensive treatment or control. The primary outcome was a combination of death and major disability (a modified Rankin score ≥3) at 14 days or hospital discharge or at the 3 month follow-up visit. Multiple logistic regression analysis was used to adjust for baseline age, gender, SBP, NIHSS score, time of stroke onset, history of antihypertensive treatment, and intervention assignment.
Results: Compared to patients with a >0-10% reduction in systolic BP within the first 24 hours after admission, the multivariable-adjusted odds ratios (95% confidence interval [CI]) for patients with ≤0%, 11-20%, and ≥21% reduction in SBP were 1.40 (1.08, 1.82), 1.00 (0.81, 1.23), and 0.98 (0.73, 1.30) at 14 days or hospital discharge; and 1.31 (1.00, 1.71), 0.82 (0.66, 1.02), and 0.78 (0.58, 1.05) at 3 months follow-up. Compared to patients with a BP 130-139/85-89 mmHg at 7 days after admission, the multivariable-adjusted odds ratios (95% CI) for patents with BP <130/85, 140-159/90-99, and ≥160/100 mmHg were 1.07 (0.82, 1.38), 1.09 (0.89, 1.34), and 1.58 (1.18, 2.11) at 14 days or hospital discharge, and 0.89 (0.67, 1.17), 1.10 (0.89, 1.36), and 1.50 (1.11, 2.03) at 3 months follow-up, respectively.
Conclusions: These data indicate that a lack of BP reduction in the first 24 hours of hospitalization and higher BP levels at 7 days after admission predict increased risk of death and major disability at 14 days or hospital discharge and at 3 months follow-up.
Author Disclosures: J. He: None. Y. Zhang: None. T. Xu: None. Q. Zhao: None. C. Chen: None. W. Tong: None. K. Mills: None. J. Chen: None.
- © 2014 by American Heart Association, Inc.