Background Whether mean arterial pressure(MAP)and pulse pressure(PP),two indicators of cerebral perfusion,could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain.Our st...Background Whether mean arterial pressure(MAP)and pulse pressure(PP),two indicators of cerebral perfusion,could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain.Our study was to explore the impact of early anti-hypertensive intervention on adverse clinical outcomes following ischaemic stroke stratified by the levels of MAP and PP based on the China Antihypertensive Trial in Acute Ischemic Stroke(CATIS).Methods The trial randomised 4071 acute ischaemic stroke patients with elevated systolic blood pressure(SBP)to receive anti-hypertensive treatment(targeting a 10%-25%reduction in SBP during the 24 hours postrandomisation,reaching a BP level<140/90 mm Hg in 7 days,further keeping these levels throughout hospitalisation)or discontinue anti-hypertensive treatment during hospitalisation.The primary outcome was death or major disability at 14 days or hospital discharge.Study outcomes were analysed by comparing the BP-lowering intervention group and control group,stratified by tertiles of MAP or PP levels.Results No significant difference was observed in the primary outcome between the intervention and control groups across all MAP(p=0.69 for homogeneity)and PP(p=0.78 for homogeneity)categories.The corresponding odds ratios(95%CIs)were 1.08(0.85-1.36),0.92(0.74-1.15)and 1.00(0.81-1.25)for participants with low,intermediate,and high MAP and were 0.99(0.79-1.25),1.06(0.84-1.34)and 0.95(0.77-1.18)for participants in PP subgroups,respectively.Furthermore,early anti-hypertensive intervention was not associated with secondary outcomes(including neurological deterioration,recurrent stroke,vascular events and all-cause mortality)by MAP and PP(all p>0.05).Conclusions Early anti-hypertensive therapy neither decreased nor increased the odds of major disability,mortality,recurrent stroke or vascular events in patients with acute ischaemic stroke regardless of different MAP and PP levels.展开更多
基金funded by a Project of the Priority Academic Program Development of Jiangsu Higher Education Institutions(Grant no-NA)Project of MOE Key Laboratory of Geriatric Diseases and Immunology(JYN202406)+1 种基金Interdisciplinary Basic Frontier Innovation Program of Suzhou Medical College of Soochow University(YXY2302013)National Natural Science Foundation of China(82273706 and 82220108001).
文摘Background Whether mean arterial pressure(MAP)and pulse pressure(PP),two indicators of cerebral perfusion,could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain.Our study was to explore the impact of early anti-hypertensive intervention on adverse clinical outcomes following ischaemic stroke stratified by the levels of MAP and PP based on the China Antihypertensive Trial in Acute Ischemic Stroke(CATIS).Methods The trial randomised 4071 acute ischaemic stroke patients with elevated systolic blood pressure(SBP)to receive anti-hypertensive treatment(targeting a 10%-25%reduction in SBP during the 24 hours postrandomisation,reaching a BP level<140/90 mm Hg in 7 days,further keeping these levels throughout hospitalisation)or discontinue anti-hypertensive treatment during hospitalisation.The primary outcome was death or major disability at 14 days or hospital discharge.Study outcomes were analysed by comparing the BP-lowering intervention group and control group,stratified by tertiles of MAP or PP levels.Results No significant difference was observed in the primary outcome between the intervention and control groups across all MAP(p=0.69 for homogeneity)and PP(p=0.78 for homogeneity)categories.The corresponding odds ratios(95%CIs)were 1.08(0.85-1.36),0.92(0.74-1.15)and 1.00(0.81-1.25)for participants with low,intermediate,and high MAP and were 0.99(0.79-1.25),1.06(0.84-1.34)and 0.95(0.77-1.18)for participants in PP subgroups,respectively.Furthermore,early anti-hypertensive intervention was not associated with secondary outcomes(including neurological deterioration,recurrent stroke,vascular events and all-cause mortality)by MAP and PP(all p>0.05).Conclusions Early anti-hypertensive therapy neither decreased nor increased the odds of major disability,mortality,recurrent stroke or vascular events in patients with acute ischaemic stroke regardless of different MAP and PP levels.
