Abstract TP403: Blood Pressure Reduction on Two-Year Mortality and Major Disability in Patients With Acute Ischemic Stroke According to Time to Treatment

Abstract

Introduction: The optimal time to initiate antihypertensive therapy among patients with acute ischemic stroke remains uncertain. We tested the effects of blood pressure (BP) reduction on two-year mortality and major disability in acute ischemic stroke patients according to time from onset to initiation of antihypertensive treatment. 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, the differences in SBP reductions were 8.7, 9.5, and 9.6 mmHg between the antihypertensive treatment and control groups among patients receiving treatment within less than 12, 12-23, and 24-48 hours after stroke onset, respectively (P<0.001 in all subgroups). At two-year follow-up, study outcomes were obtained in 1,945 (95.4%) participants in the treatment group and 1,925 (94.7%) in the control group. The event rates of primary outcome were not statistically significantly different between the antihypertensive treatment group and the control group according to time to treatment (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 time to initiation of treatment.