Blood Pressure Reduction Ineffective in Acute Stroke Treatment

The use of antihypertensive drugs to lower systolic blood pressure (SBP) as part of the acute treatment of ischemic stroke does not reduce early mortality or disability, according to a new study.

Researchers at Tulane University (New Orleans, LA, USA) and Soochow University (Suzhou, China) conducted a single-blind, randomized clinical trial involving 4,071 patients with nonthrombolyzed ischemic stroke within 48 hours of onset, together with elevated SBP. The patients were randomly assigned to receive antihypertensive treatment, aimed at lowering SBP by 10%–25% within the first 24 hours after randomization (2,038 patients), or to discontinue all antihypertensive medications during hospitalization (2,033 controls). The primary outcome was a combination of death and major disability at 14 days or hospital discharge.

The results showed that at 14 days after randomization, there were 683 events among patients who received early aggressive antihypertensive therapy, versus 681 events in the control group. At three months, there were 500 additional events in the treatment arm versus 502 among controls. The lack of benefit occurred despite the fact that antihypertensive therapy achieved a rapid and significant reduction in SBP, down from 166.7 mmHg to 144.7 mmHg (12.7% reduction) within 24 hours, versus a 7.2% reduction in the control group. The study was published online on November 17, 2013, in the Journal of the American Medical Association (JAMA).

“Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge,” concluded lead author Jiang He, MD, PhD, and colleagues.

Typically, more attention is given to SBP as a major risk factor for cardiovascular disease (CVD) in people 50 years old and over. In most people, SBP rises steadily with age due to increasing stiffness of large arteries, long-term build-up of plaque, and increased incidence of CVD.

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Tulane University
Soochow University