Blood Pressure Reduction On Two-Year Mortality And Major Disability In Acute Ischemic Stroke With Various Severities.

Introduction: We conducted a prespecified subgroup analysis to assess whether disease severity modifies the effect of early antihypertensive treatment on two-year mortality and major disability in acute ischemic stroke patients. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke, a randomized, single-blind, blinded end-points trial, was conducted in 4,071 patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP). Patients were randomly assigned to receive antihypertensive treatment (n=2,038) or to discontinue all antihypertensive medications (n=2,033) during hospitalization. Post-treatment follow-ups were conducted at 3, 12, and 24 months after hospital discharge. The primary outcome was a composite of death and major disability at the two-year follow-up visit. Results: At 24 hours after randomization, mean SBP differences (95% CIs) were -8.5 (-10.0 to -7.1), -9.8 (-11.4 to -8.3), and -9.1 (-14.4 to -3.8) mmHg between the treatment and control groups (all P <0.001) for patients with a baseline NIHSS score of 0-4, 5-15, and ≥16, respectively. At day 7 after randomization, the corresponding mean SBP differences were -9.3 (-10.5 to -8.2), -9.1 (-10.3 to -7.8), and -10.1 (-15.1 to -5.1) mm Hg between the treatment and control groups (all P <0.001). The event rates of primary outcome were not statistically significantly different between the antihypertensive treatment group and the control group according to baseline NIH stroke score or Rankin score (Table). Conclusions: Among patients with acute ischemic stroke, BP reduction with antihypertensive medications during hospitalization did not reduce or increase the composite outcome of death and major disability over two years according to disease severity at baseline.