Department of Epidemiology, School of Public Health and Tropical Medicine.
Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, Maryland, USA.
J Hypertens. 2018 Jun;36(6):1372-1381. doi: 10.1097/HJH.0000000000001690.
We studied the effect of early antihypertensive treatment on death, major disability, and vascular events among patients with acute ischemic stroke according to their baseline SBP.
We randomly assigned 4071 acute ischemic stroke patients with SBP between 140 and less than 220 mmHg to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. A composite primary outcome of death and major disability and secondary outcomes were compared between treatment and control stratified by baseline SBP levels of less than 160, 160-179, and at least 180 mmHg.
At 24 h after randomization, differences in SBP reductions were 8.8, 8.6 and 7.8 mmHg between the antihypertensive treatment and control groups among patients with baseline SBP less than 160, 160-179, and at least 180 mmHg, respectively (P < 0.001 among subgroups). At day 14 or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups among subgroups. However, there was a significant interaction between antihypertensive treatment and baseline SBP subgroups on death (P = 0.02): odds ratio (95% CI) of 2.42 (0.74-7.89) in patients with baseline SBP less than 60 mmHg and 0.34 (0.11-1.09) in those with baseline SBP at least 180 mmHg. At the 3-month follow-up, the primary and secondary clinical outcomes were not significantly different between the treatment and control groups by baseline SBP levels.
Early antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with various baseline SBP levels. Future clinical trials are warranted to test BP-lowering effects in acute ischemic stroke patients by baseline SBP levels.
ClinicalTrials.gov Identifier: NCT01840072.
我们根据基线收缩压（SBP）研究了急性缺血性脑卒中患者早期降压治疗对死亡、主要残疾和血管事件的影响。
我们将 4071 例 SBP 为 140 至 220mmHg 的急性缺血性脑卒中患者随机分为降压治疗组或住院期间停用所有降压药物组。比较治疗组和对照组之间基线 SBP＜160mmHg、160-179mmHg 和至少 180mmHg 患者的复合主要结局（死亡和主要残疾）和次要结局。
随机分组后 24 小时，基线 SBP＜160mmHg、160-179mmHg 和至少 180mmHg 的患者降压治疗组与对照组之间 SBP 降低幅度分别为 8.8、8.6 和 7.8mmHg（亚组间 P＜0.001）。第 14 天或出院时，各亚组治疗组和对照组之间主要和次要结局无显著差异。然而，降压治疗与基线 SBP 亚组之间的死亡存在显著交互作用（P＝0.02）：基线 SBP＜60mmHg 的患者比值比（95%可信区间）为 2.42（0.74-7.89），而基线 SBP 至少 180mmHg 的患者比值比为 0.34（0.11-1.09）。3 个月随访时，各亚组治疗组和对照组之间主要和次要临床结局无显著差异。
在不同基线 SBP 水平的急性缺血性脑卒中患者中，早期降压治疗对临床结局无影响。有必要开展未来的临床试验，根据基线 SBP 水平测试急性缺血性脑卒中患者的降压效果。
ClinicalTrials.gov 标识符：NCT01840072。
