Abstract P221: Effects of Immediate Antihypertensive Treatment in Men and Women with Acute Ischemic Stroke: The CATIS Study

Abstract

Gender difference in the risk and prognosis of ischemic stroke has been reported. We examined the effects of immediate antihypertensive treatment on clinical outcomes among acute ischemic stroke by gender in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). CATIS was a randomized, single-blind, and blinded end-point trial conducted in 4,071 acute ischemic stroke patients (2,604 men and 1,467 women). Eligible stroke patients with elevated systolic blood pressure (SBP) were randomly assigned to receive antihypertensive treatment (lowering SBP by 10-25% within the first 24 hours after randomization and BP < 140/90 mm Hg within 7 days) or control (discontinuing all antihypertensive medications). The primary outcome was a combination of death and major disability (defined by a modified Rankin score ≥ 3) at day 14 (or at discharge if earlier than 14 days) and 3-month post-treatment follow-up. The primary outcome was not significantly different between the treatment and control groups in either men or women. The primary outcome event rates for the two comparison groups were 31.6% and 32.1% in men ( P = 0.79) and 37.3% and 36.1% in women ( P = 0.65) at day 14; and were 23.6% and 24.5% in men ( P = 0.60) and 28.0% and 26.6% in women ( P = 0.56) at 3-month follow-up. The secondary outcomes were not different between treatment and control groups among men and women at 14 days or hospital discharge and at 3 months. The median modified Rankin scores (interquartile range) for the comparison groups were 2.0 (1.0-3.0) and 2.0 (1.0-3.0) in both men and women at day 14 or hospital discharge. The modified Rankin score, recurrent stroke, vascular event, and all-cause mortality at 3-month follow-up were similar between the treatment and control groups for both men and women. For example, the vascular event rates for the comparison groups were 2.4% and 3.0% in men ( P = 0.34) and 2.4% and 2.9% in women ( P = 0.58). There were no significant treatment and sex interactions for any of the primary and secondary outcomes. In conclusion, these data suggest that immediate antihypertensive treatment within the first 48 hours after stroke onset has no gender-specific effect on short-term outcomes of patients with acute ischemic stroke.