Abstract 18868: Effects of Immediate Blood Pressure Reduction in Acute Ischemic Stroke by History of Antihypertension Medication Use
The optimal strategy for managing elevated blood pressure (BP) in acute ischemic stroke has not been definitively established. In a pre-specified subgroup analysis of CATIS, we examined whether a history of antihypertensive medication use modifies the effects of early BP reduction on death or major disability, recurrent stroke, and vascular events. CATIS enrolled ischemic stroke patients with elevated systolic BP (SBP) and randomly assigned them, within 48 hours of onset and stratified by history of antihypertensive medication use, to antihypertensive treatment (N=2038) aimed at a 10-25% decrease in SBP within 24 h and a BP<140/90 by day 7 or to a control group that discontinued all antihypertensive medications (N=2033). The primary outcome was death or major disability (modified Rankin Scale score >3) at 14 days or hospital discharge. Mean SBP differences (95% CIs) between treatment and control groups were -8.7 (-10.2, -7.2) mm Hg among patients with a history of antihypertensive medication use and -9.6 (-11.0, -8.2) in those with no use (both p<0.001) at 24 h after randomization and -9.3 (95% CI 10.5, -8.1; p<0.001) in both subgroups at day 7. Death or major disability at 14 days or hospital discharge was not significantly different between treatment and control in participants with a history of antihypertensive medication use (OR=1.07; 95% CI 0.89, 1.29; p=0.50) and those with no use (OR=0.95; 95% CI 0.79, 1.13; p=0.54). Similarly, death or major disability at 3 months was not significantly different between treatment and control in patients with a history of antihypertensive medication use (OR=1.04, 95% CI 0.85 to 1.28; p=0.68) and those with no use (OR=0.95; 95% CI 0.78, 1.16; p=0.63). There was a significant reduction in recurrent stroke at 3 months in the treatment group among those with use of antihypertensive medications (OR=0.42; 95% CI 0.21, 0.86; p=0.02) but no significant reduction in those with no use (OR=0.97; 95% CI 0.50, 1.90; p=0.94). Our study indicates that immediate BP lowering in acute ischemic stroke has a neutral effect on death or major disability regardless of history of antihypertensive medication use. However, there is a potential beneficial effect on recurrent stroke only among patients with a history of antihypertensive medication use.
Author Disclosures: K. Obst: None. T. Xu: None. Y. Zhang: None. H. Peng: None. X. Bu: None. C. Chen: None. J. Chen: None. J. He: None.
- © 2016 by American Heart Association, Inc.