Regional Differences in Early BP Management After Acute Ischemic Stroke in the ENCHANTED International Randomized Controlled Trials.

Chen Chen,Lili Song,John Chalmers,Jie Yang,Craig S Anderson,Hisatomi Arima,Richard Lindley,Xia Wang,Thompson Robinson

doi:10.3389/fneur.2021.687862

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 of thrombolysis-eligible acute ischemic stroke (AIS) patients with elevated systolic BP (SBP >150 mmHg) assigned to intensive (target SBP 130-140 mmHg) vs. guideline-recommended (SBP <180 mmHg) treatment; BP management was compared among four regions: Western countries (Italy/United Kingdom/Spain/Australia), China (mainland), other Asia (Hong Kong/Taiwan/Singapore/Thailand/Vietnam/India), and South America (Chile/Brazil/Colombia).Results: These analyses included 2,196 AIS [38% women, mean age 67 (12) years] patients. Commonly used intravenous BP-lowering agents were labetalol, nitroglycerin, and topical nitrates in Western countries; urapidil and sodium nitroprusside in China; nicardipine in other Asian countries; and sodium nitroprusside and labetalol in South America. Chinese patients were less likely to receive BP-lowering treatment in the first 24 h and be treated with multiple agents although they had smaller magnitude of SBP reduction and lower SBP variability.Conclusion: Regional variations in early BP management in acute stroke translated into differences in early BP control parameters.

Highlights

Elevated blood pressure (BP) is one of the leading modifiable risk factors for stroke, including both intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) [1]
Data are from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), a partial-factorial, international randomized controlled trial of thrombolysis-eligible acute ischemic stroke (AIS) patients with elevated systolic BP (SBP >150 mmHg) assigned to intensive vs. guideline-recommended (SBP
75% of patients have high BP, and 50% of those have a prior history of hypertension [2, 3]

Summary

Introduction

Elevated blood pressure (BP) is one of the leading modifiable risk factors for stroke, including both intracerebral hemorrhage (ICH) and acute ischemic stroke (AIS) [1]. Large-scale epidemiological studies demonstrate significant variations in hypertension management at the country level and that within countries [4, 5]. Evidence on the variation in early BP management after acute stroke is scarce. In the context of thrombolysis and BP management in AIS, the Enhanced Control of Hypertension and Thrombolysis in Stroke Study (ENCHANTED) [6, 7] enrolled patients at 110 hospitals in 14 countries. Most Asian participants were from middle income countries. This trial provides an ideal population to understand the regional differences in early BP management after AIS world widely. 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

Results

Conclusion