Effect of reducing blood pressure with medications immediately following ischemic stroke

Jiang He, M.D., Ph.D., of the Tulane University School of Public Health and Tropical Medicine, New Orleans, and colleagues examined whether moderate lowering of blood pressure within the first 48 hours after the onset of an acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge.

"Stroke is the second leading cause of death and the leading cause of serious, long-term disability worldwide. Clinical trials have documented that lowering reduces the risk of in hypertensive and normotensive patients with a history of stroke or . Although the benefit of lowering blood pressure for primary and secondary prevention of stroke has been established, the effect of immediate antihypertensive treatment in patients with acute ischemic stroke and elevated blood pressure is uncertain," according to background information in the article.

The China Antihypertensive Trial in Acute Ischemic Stroke, a randomized controlled trial, was conducted among 4,071 patients with ischemic stroke within 48 hours of symptom onset and elevated . Patients were recruited from 26 hospitals across China between August 2009 and May 2013. Patients (n = 2,038) were assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10 percent to 25 percent within the first 24 hours after randomization, achieving blood pressure less than 140/90 mm Hg within 7 days, and maintaining this level during hospitalization) or to discontinue all antihypertensive medications (control) during hospitalization (n = 2,033).

Average systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg (-12.7 percent) within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg (-7.2 percent) in the control group within 24 hours after randomization. Average systolic blood pressure was 137.3 mm Hg in the antihypertensive treatment group and 146.5 mm Hg in the control group at day 7 after randomization. The primary outcome (a combination of death and major disability at 14 days or hospital discharge) did not differ between treatment groups (683 events [antihypertensive treatment] vs. 681 events [control]) at 14 days or . The secondary composite outcome of death and major disability at 3-month posttreatment follow-up did not differ between treatment groups.

These findings suggest that the decision to lower blood pressure with antihypertensive treatment in patients with does not improve or worsen outcome and therefore should be based on individual clinical judgment, the authors write.

More information: JAMA doi:10.l001/jama.2013.282543

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Cerebrovascular reserve-based strategy is cost-effective

Jan 29, 2015

(HealthDay)—A decision rule based on assessment of cerebrovascular reserve (CVR) seems to be cost-effective for prevention of stroke in asymptomatic patients with carotid artery stenosis, according to a ...

New hypertension guidelines could save lives and money

Jan 28, 2015

Full implementation of new hypertension guidelines could prevent 56,000 cardiovascular disease events (mostly heart attacks and strokes) and 13,000 deaths each year, without increasing overall health care costs, an analysis ...

Manchester United's rising stars revolutionize heart health

Jan 28, 2015

A unique research project to identify the effects of exercise on young hearts has been announced today [Wednesday 28 January 2015]. Manchester United's Academy players are being put through their paces having their hearts ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.