Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke

The CATIS randomized clinical trial

Jiang He, Yonghong Zhang, Tan Xu, Qi Zhao, Dali Wang, Chung Shiuan Chen, Weijun Tong, Changjie Liu, Tian Xu, Zhong Ju, Yanbo Peng, Hao Peng, Qunwei Li, Deqin Geng, Jintao Zhang, Dong Li, Fengshan Zhang, Libing Guo, Yingxian Sun, Xuemei Wang & 8 others Yong Cui, Yongqiu Li, Dihui Ma, Guang Yang, Yanjun Gao, Xiaodong Yuan, Lydia A. Bazzano, Jing Chen

Research output: Contribution to journalArticle

178 Citations (Scopus)

Abstract

IMPORTANCE: Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain. OBJECTIVE: To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge. DESIGN, SETTING, AND PARTICIPANTS: The China Antihypertensive Trial in Acute Ischemic Stroke, a single-blind, blinded end-points randomized clinical trial, conducted among 4071 patients with nonthrombolysed ischemic stroke within 48 hours of onset and elevated systolic blood pressure. Patients were recruited from 26 hospitals across China between August 2009 and May 2013. INTERVENTIONS: Patients (n = 2038) were randomly assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10% to 25% 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 = 2033). MAIN OUTCOMES AND MEASURES: Primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at 14 days or hospital discharge. RESULTS: Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg (-12.7%) within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg (-7.2%) in the control group within 24 hours after randomization (difference, -5.5% [95% CI, -4.9 to -6.1%]; absolute difference, -9.1 mm Hg [95% CI, -10.2 to -8.1]; P < .001). Mean 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 (difference, -9.3 mm Hg [95% CI, -10.1 to -8.4]; P < .001). The primary outcome did not differ between treatment groups (683 events [antihypertensive treatment] vs 681 events [control]; odds ratio, 1.00 [95% CI, 0.88 to 1.14]; P = .98) at 14 days or hospital discharge. The secondary composite outcome of death and major disability at 3-month posttreatment follow-up did not differ between treatment groups (500 events [antihypertensive treatment] vs 502 events [control]; odds ratio, 0.99 [95% CI, 0.86 to 1.15]; P = .93). CONCLUSION AND RELEVANCE: Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01840072.

Original languageEnglish (US)
Pages (from-to)479-489
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume311
Issue number5
DOIs
StatePublished - Feb 12 2014
Externally publishedYes

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Randomized Controlled Trials
Stroke
Antihypertensive Agents
Blood Pressure
Random Allocation
Therapeutics
China
Hospitalization
Odds Ratio
Control Groups
Primary Prevention
Secondary Prevention
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke : The CATIS randomized clinical trial. / He, Jiang; Zhang, Yonghong; Xu, Tan; Zhao, Qi; Wang, Dali; Chen, Chung Shiuan; Tong, Weijun; Liu, Changjie; Xu, Tian; Ju, Zhong; Peng, Yanbo; Peng, Hao; Li, Qunwei; Geng, Deqin; Zhang, Jintao; Li, Dong; Zhang, Fengshan; Guo, Libing; Sun, Yingxian; Wang, Xuemei; Cui, Yong; Li, Yongqiu; Ma, Dihui; Yang, Guang; Gao, Yanjun; Yuan, Xiaodong; Bazzano, Lydia A.; Chen, Jing.

In: JAMA - Journal of the American Medical Association, Vol. 311, No. 5, 12.02.2014, p. 479-489.

Research output: Contribution to journalArticle

He, J, Zhang, Y, Xu, T, Zhao, Q, Wang, D, Chen, CS, Tong, W, Liu, C, Xu, T, Ju, Z, Peng, Y, Peng, H, Li, Q, Geng, D, Zhang, J, Li, D, Zhang, F, Guo, L, Sun, Y, Wang, X, Cui, Y, Li, Y, Ma, D, Yang, G, Gao, Y, Yuan, X, Bazzano, LA & Chen, J 2014, 'Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: The CATIS randomized clinical trial', JAMA - Journal of the American Medical Association, vol. 311, no. 5, pp. 479-489. https://doi.org/10.1001/jama.2013.282543
He, Jiang ; Zhang, Yonghong ; Xu, Tan ; Zhao, Qi ; Wang, Dali ; Chen, Chung Shiuan ; Tong, Weijun ; Liu, Changjie ; Xu, Tian ; Ju, Zhong ; Peng, Yanbo ; Peng, Hao ; Li, Qunwei ; Geng, Deqin ; Zhang, Jintao ; Li, Dong ; Zhang, Fengshan ; Guo, Libing ; Sun, Yingxian ; Wang, Xuemei ; Cui, Yong ; Li, Yongqiu ; Ma, Dihui ; Yang, Guang ; Gao, Yanjun ; Yuan, Xiaodong ; Bazzano, Lydia A. ; Chen, Jing. / Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke : The CATIS randomized clinical trial. In: JAMA - Journal of the American Medical Association. 2014 ; Vol. 311, No. 5. pp. 479-489.
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author = "Jiang He and Yonghong Zhang and Tan Xu and Qi Zhao and Dali Wang and Chen, {Chung Shiuan} and Weijun Tong and Changjie Liu and Tian Xu and Zhong Ju and Yanbo Peng and Hao Peng and Qunwei Li and Deqin Geng and Jintao Zhang and Dong Li and Fengshan Zhang and Libing Guo and Yingxian Sun and Xuemei Wang and Yong Cui and Yongqiu Li and Dihui Ma and Guang Yang and Yanjun Gao and Xiaodong Yuan and Bazzano, {Lydia A.} and Jing Chen",
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TY - JOUR

T1 - Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke

T2 - The CATIS randomized clinical trial

AU - He, Jiang

AU - Zhang, Yonghong

AU - Xu, Tan

AU - Zhao, Qi

AU - Wang, Dali

AU - Chen, Chung Shiuan

AU - Tong, Weijun

AU - Liu, Changjie

AU - Xu, Tian

AU - Ju, Zhong

AU - Peng, Yanbo

AU - Peng, Hao

AU - Li, Qunwei

AU - Geng, Deqin

AU - Zhang, Jintao

AU - Li, Dong

AU - Zhang, Fengshan

AU - Guo, Libing

AU - Sun, Yingxian

AU - Wang, Xuemei

AU - Cui, Yong

AU - Li, Yongqiu

AU - Ma, Dihui

AU - Yang, Guang

AU - Gao, Yanjun

AU - Yuan, Xiaodong

AU - Bazzano, Lydia A.

AU - Chen, Jing

PY - 2014/2/12

Y1 - 2014/2/12

N2 - IMPORTANCE: Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain. OBJECTIVE: To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge. DESIGN, SETTING, AND PARTICIPANTS: The China Antihypertensive Trial in Acute Ischemic Stroke, a single-blind, blinded end-points randomized clinical trial, conducted among 4071 patients with nonthrombolysed ischemic stroke within 48 hours of onset and elevated systolic blood pressure. Patients were recruited from 26 hospitals across China between August 2009 and May 2013. INTERVENTIONS: Patients (n = 2038) were randomly assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10% to 25% 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 = 2033). MAIN OUTCOMES AND MEASURES: Primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at 14 days or hospital discharge. RESULTS: Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg (-12.7%) within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg (-7.2%) in the control group within 24 hours after randomization (difference, -5.5% [95% CI, -4.9 to -6.1%]; absolute difference, -9.1 mm Hg [95% CI, -10.2 to -8.1]; P < .001). Mean 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 (difference, -9.3 mm Hg [95% CI, -10.1 to -8.4]; P < .001). The primary outcome did not differ between treatment groups (683 events [antihypertensive treatment] vs 681 events [control]; odds ratio, 1.00 [95% CI, 0.88 to 1.14]; P = .98) at 14 days or hospital discharge. The secondary composite outcome of death and major disability at 3-month posttreatment follow-up did not differ between treatment groups (500 events [antihypertensive treatment] vs 502 events [control]; odds ratio, 0.99 [95% CI, 0.86 to 1.15]; P = .93). CONCLUSION AND RELEVANCE: Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01840072.

AB - IMPORTANCE: Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain. OBJECTIVE: To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge. DESIGN, SETTING, AND PARTICIPANTS: The China Antihypertensive Trial in Acute Ischemic Stroke, a single-blind, blinded end-points randomized clinical trial, conducted among 4071 patients with nonthrombolysed ischemic stroke within 48 hours of onset and elevated systolic blood pressure. Patients were recruited from 26 hospitals across China between August 2009 and May 2013. INTERVENTIONS: Patients (n = 2038) were randomly assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10% to 25% 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 = 2033). MAIN OUTCOMES AND MEASURES: Primary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at 14 days or hospital discharge. RESULTS: Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg (-12.7%) within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg (-7.2%) in the control group within 24 hours after randomization (difference, -5.5% [95% CI, -4.9 to -6.1%]; absolute difference, -9.1 mm Hg [95% CI, -10.2 to -8.1]; P < .001). Mean 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 (difference, -9.3 mm Hg [95% CI, -10.1 to -8.4]; P < .001). The primary outcome did not differ between treatment groups (683 events [antihypertensive treatment] vs 681 events [control]; odds ratio, 1.00 [95% CI, 0.88 to 1.14]; P = .98) at 14 days or hospital discharge. The secondary composite outcome of death and major disability at 3-month posttreatment follow-up did not differ between treatment groups (500 events [antihypertensive treatment] vs 502 events [control]; odds ratio, 0.99 [95% CI, 0.86 to 1.15]; P = .93). CONCLUSION AND RELEVANCE: Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01840072.

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