Abstract WP390: Regional Differences in Blood Pressure Management After Acute Stroke in International Randomized Controlled Trials

Abstract

Background and Aims: Epidemiological studies show significant variations in hypertension management within and between countries. The level of regional variation in early blood pressure (BP) management after acute stroke is uncertain. Methods: Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), a partial-factorial, international randomized controlled trial (RCT) of thrombolysis-eligible acute ischemic stroke (AIS) patients with systolic BP (SBP >150 mmHg) assigned to intensive (target SBP 130-140 mmHg) vs. guideline-recommended (SBP <180 mmHg) treatment; and INTERACT2, an international RCT of patients with spontaneous intracerebral hemorrhage (ICH) (<6 hours) with elevated SBP randomized to intensive (target SBP <140 mmHg) or guideline-recommended (SBP <180 mmHg) treatment. BP management was compared between five participating regions of these RCTs: west (Europe/Australia/US), China, other Asia (South Korea, Singapore, Thailand, Vietnam), India (India and Pakistan), and South America (Argentina, Chile, Brazil, Colombia). Results: There were 2196 AIS (38% women, mean age 67[12] years) and 2829 acute ICH (37% women, mean age 63[13] years) patients in these analyzes. Commonly used intravenous BP lowering agents are labetalol, nitroglycerin, and topical Nitrates in western countries; mannitol, urapidil, and sodium nitroprusside in China; nicardipine in other Asian countries; and sodium nitroprusside and labetalol in South America. Western patients were more likely to receive BP lowering treatment in the first 24 hours and treated with multiple agents, and had larger magnitude of SBP reduction and greater SBP variability. BP control parameters over 2-7 days were comparable between regions. Conclusion: Regional variations in early BP management in acute stroke translated into differences in magnitude of SBP reduction and SBP variability in patients.