Xu Tan, Zhang Yonghong, Bu Xiaoqing, Wang Dali, Sun Yingxian, Chen Chung-Shiuan, Wang Jinchao, Peng Hao, Ju Zhong, Peng Yanbo, Xu Tian, Li Qunwei, Geng Deqin, Zhang Jintao, Li Dong, Zhang Fengshan, Guo Libing, Wang Xuemei, Cui Yong, Li Yongqiu, Ma Dihui, Zhang Dongsheng, Yang Guang, Gao Yanjun, Yuan Xiaodong, Chen Jing, He Jiang
aSchool of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, Jiangsu, China bTulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA cAffiliated Hospital of Hebei United University, Shijiazhuang, Hebei dFirst Affiliated Hospital of China Medical University, Shenyang, Liaoning eYutian County Hospital, Tangshan, Hebei fKerqin District First People's Hospital of Tongliao City, Tongliao, Inner Mongolia gAffiliated Hospital of Nantong University, Nantong, Jiangsu hSchool of Public Health, Taishan Medical College, Tai'an, Shandong iAffiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu jThe 88th Hospital of PLA kFeicheng City People's Hospital, Tai'an, Shandong lTongliao Municipal Hospital, Tongliao, Inner Mongolia mSiping Central Hospital, Siping nJilin Central Hospital, Jilin City oGeneral Hospital of First Automobile Works, Changchun, Jilin pTangshan Worker's Hospital, Tangshan, Hebei qFirst Affiliated Hospital of Jilin University, Changchun, Jilin rDongping County People's Hospital, Tai'an, Shandong sSecond People's Hospital of Huaian City, Huai'an, Jiangsu tAffiliated Hospital of Chengde Medical College, Chengde, Hebei uKailuan General Hospital, Tangshan, Hebei, China vTulane University School of Medicine, New Orleans, Louisiana, USA.
J Hypertens. 2017 Jun;35(6):1244-1251. doi: 10.1097/HJH.0000000000001288.
The optimal time to initiate antihypertensive therapy among patients with acute ischemic stroke remains uncertain. We tested the effects of blood pressure reduction among patients with acute ischemic stroke according to time from onset to initiation of antihypertensive treatment.
We randomly assigned 4071 acute ischemic stroke patients with elevated SBP to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. The primary outcome was a combination of death and major disability, and secondary outcomes included the modified Rankin score, recurrent stroke, vascular disease events, and all-cause mortality.
At 24 h 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 h after stroke onset, respectively (P < 0.001 in all subgroups). At day 14 or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups in all subgroups. At the 3-month follow-up, death or major disability [odds ratio (OR) 0.73; 95% confidence interval (CI) 0.55-0.96; P = 0.03], recurrent stroke (OR 0.25; 95% CI 0.08-0.74; P = 0.01), and vascular events (OR 0.41; 95% CI 0.18-0.95; P = 0.04) were significantly reduced in the antihypertensive treatment group only among participants who received treatment between 24 and 48 h.
Blood pressure reduction might reduce 3-month death and major disability and recurrent stroke among patients with acute ischemic stroke who receive antihypertensive treatment between 24 and 48 h after stroke onset.
ClinicalTrials.gov Identifier: NCT01840072.
急性缺血性脑卒中患者开始抗高血压治疗的最佳时机仍不确定。我们根据从发病到开始抗高血压治疗的时间，测试了急性缺血性脑卒中患者血压降低的效果。
我们将4071例收缩压升高的急性缺血性脑卒中患者随机分组，使其在住院期间接受抗高血压治疗或停用所有抗高血压药物。主要结局是死亡和严重残疾的综合情况，次要结局包括改良Rankin量表评分、复发性脑卒中、血管疾病事件和全因死亡率。
随机分组后24小时，在卒中发作后不到12小时、12 - 23小时和24 - 48小时内接受治疗的患者中，抗高血压治疗组与对照组之间收缩压降低的差异分别为8.7、9.5和9.6 mmHg（所有亚组P < 0.001）。在第14天或出院时，所有亚组的治疗组和对照组之间的主要和次要结局均无显著差异。在3个月随访时，仅在卒中发作后24至48小时接受治疗的参与者中，抗高血压治疗组的死亡或严重残疾[比值比（OR）0.73；95%置信区间（CI）0.55 - 0.96；P = 0.03]、复发性脑卒中（OR 0.25；95% CI 0.08 - 0.74；P = 0.01）和血管事件（OR 0.41；95% CI 0.18 - 0.95；P = 0.04）显著降低。
对于在卒中发作后24至48小时接受抗高血压治疗的急性缺血性脑卒中患者，降低血压可能会降低3个月时的死亡和严重残疾以及复发性脑卒中的风险。
ClinicalTrials.gov标识符：NCT01840072。
