Delayed antihypertensive therapy may not affect outcome of acute ischemic stroke

Researchers observed no difference in 3-month functional outcomes or mortality in patients with acute ischemic stroke who underwent early blood pressure-lowering therapy versus a delayed strategy, a speaker reported. .

The results of the CATIS-2 trial were presented at the International Stroke Conference.

“Raised blood pressure is very common in the acute stage and is strongly associated with poor neurological function and recurrence of ischemic stroke. There is great concern in clinical practice and clinical research whether we have need for blood pressure reduction at an early stage, what is the optimal timing and the choice of drugs, ” Liping Liu, MD, Ph.D., from Beijing Tiantan Hospital, Capital Medical University and the National Neurological Disease Clinical Research Center, said during a presentation. “There are no randomized trials to compare early versus delayed initiation of blood pressure reduction in acute ischemic stroke.”

In the original CATIS trial, researchers assessed whether a moderate drop in blood pressure in the first 48 hours after the onset of an acute ischemic stroke reduce death or major disability at discharge from hospital and 14 days of follow-up with respect to the discontinuation of any antihypertensive treatment.

As Healio previously reporteda moderate fall in BP in the first 48 hours after onset of acute ischemic stroke was associated with no change in stroke outcome compared with discontinuation of antihypertensive drugs.

CATIS-2 was a multicenter, randomized, open-label, blinded trial that tested early versus delayed antihypertensive therapy to reduce the risk for the primary composite outcome of major disability and mortality at 3 months in 4 810 patients with acute ischemic stroke and elevated BP within 24-48 hours of onset of stroke symptoms (mean age, 64 years; 65% male).

Secondary outcomes included first recurrent stroke events within 3 months of follow-up.

Participants assigned to early antihypertensive therapy received BP-lowering drugs immediately after randomization, with target systolic BP reduced by 10% to 20% within 24 hours and mean BP below 140/90 mm Hg in 5 days maintained up to 90 days. Participants assigned to delayed antihypertensive therapy discontinued treatment for the first 7 days after randomization and resumed treatment on day 8, according to the presentation.

At 24 hours, mean systolic blood pressure was reduced by 9.7% in the early treatment group and 4.9% in the delayed treatment group (difference, 7.8 mm Hg; 95% CI, 6.7 to 8.9; P < .0001).

At 7 days, mean systolic BP was 139.1 mm Hg in the early treatment group versus 150.9 mm Hg in the delayed treatment group (clear difference, 11.9 mm Hg; 95% CI 12.9 at 10.9; P < .0001).

The researchers found no significant difference in major disability and 3-month mortality between early and delayed antihypertensive therapy for patients who experienced acute ischemic stroke (OR = 1.17; 95% CI, 0 .98-1.4; P = 0.092).

There was also no significant difference in first recurrent stroke or major vascular events within 3 months between the early and delayed antihypertensive treatment groups (recurrent stroke: OR = 1.14; 95% CI, 0 .89-1.46 P = 0.3; major vascular events: OR = 1.08; 95% CI, 0.85-1.38; P = 0.53).

Liu and colleagues observed no interaction with the primary composite outcome among predefined subgroups, including patients grouped by age, sex, baseline BP, National Institutes of Health Stroke Scale score, history hypertension, baseline antihypertensive drug use, and stroke subtype.

“Raised blood pressure is very common and associated with poor neurological function [after acute ischemic stroke]and we see no difference [in outcomes with] Early reduction in blood pressure versus delayed reductions after day 7, but antihypertensive therapy could be delayed for at least 7 days after onset, unless people with severe acute comorbidities require reductions in blood pressure. emergency blood pressure,” Lui said. “CATIS-2 is the first trial to compare early and delayed reduction in blood pressure for acute ischemic stroke and to indicate that there may be underlying mechanisms for the increase in blood pressure in the acute stage or superacute, which should be considered individually.The optimal blood pressure measurement strategy in these patients remains unclear and should be the subject of future research.

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International Stroke Conference