Early versus delayed antihypertensive treatment in patients with acute ischaemic stroke

1. In this randomized controlled trial, early compared to late blood pressure management following an acute ischemic stroke did not impact the risk of death or functional dependency at 90 days. 

Evidence rating level: 1 (Excellent)

Researchers aimed to determine whether early treatment of hypertension after an ischemic stroke impacts the risk of death or functional dependency (modified Rankin scale score ≥3). 4810 participants were included in the study, which was conducted in China between June 13, 2018, and July 10, 2022. Participants included those over age 40 who had suffered an ischemic stroke and did not receive antithrombolytic treatment. All participants were hypertensive on presentation, with systolic blood pressure (SBP) between 140 and 220 mmHg. 2413 participants were randomized to an early treatment group and received antihypertensive treatment within 24 hours of an ischemic stroke, with the goal of achieving blood pressure below 140/90 by day 7. The remaining 2397 participants were randomized into the delayed treatment group and received antihypertensive treatment starting on day 8, with the same blood pressure target of <140/90. On day 7, the mean SBP was 139.1 mmHg in the early treatment group, compared to 150.9 mmHg in the delayed treatment group (P <.001). 90 days post-stoke, there was no significant difference in the risk of death or functional dependency between the two groups; 12.0% in the early treatment group, compared to 10.5% in the delayed treatment group, P = .08. There was also no difference in the risk of recurrent strokes between these two groups. A limitation of this study is that neither participants nor physicians were blinded to the treatment assignments. As well, the majority of participants in this study had mild to moderate stroke symptoms; therefore, the data is not generalizable to stroke patients with more severe symptoms. Overall, this study demonstrates that early compared to late blood pressure management following an acute ischemic stroke does not impact the risk of death or functional dependency at 90 days.

Click to read the study in BMJ

Image: PD

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