Early vs delayed antihypertensive treatment in ischemic stroke does not reduce the odds of death or dependency in the short term, regardless of hypertension history, according to study findings published in Stroke.

Investigators in China analyzed patients with and without history of hypertension to understand how death and disability were affected by early vs delayed antihypertensive treatment. The composite of death or functional dependency (modified Rankin Scale score of at least 3) at 90 days was the primary outcome.

The investigators conducted a prespecified subgroup analysis of the China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2; ClinicalTrials.gov Identifier: NCT03479554) trial to compare patients (mean age, 63.7 years; 65.0% men) with (79.7%) and without (20.3%) hypertension history for the effect of early vs delayed antihypertensive treatment on death and disability.

These findings suggest that initiating antihypertensive treatment within the first week after ischemic stroke onset confers no significant benefit but even increases the risk of functional dependence for patients without prior hypertension.

Briefly, CATIS-2 is a randomized clinical trial performed at 106 hospitals in China from June 2018 to July 2022. Within 48 hours of acute ischemic stroke symptom onset and with systolic blood pressure (SBP) between 140 and 219 mm Hg, patients (N=4810; aged at least 40 years) were randomly assigned 1:1 to either the early treatment (within 24 to 48 hours of symptom onset; n=2413; n=1918 with hypertension history) or delayed treatment (started on day 8; n=2397; n=1911 with hypertension history). Patients with severe stroke, deep coma, severe heart failure, or acute myocardial infarction were among those excluded, as were those with SBP of at least 220 mm Hg or diastolic BP of at least 120 mm Hg. Home antihypertensive medications were discontinued at baseline.

In the current analysis, the investigators found no between-treatment group difference in mortality or functional dependence regardless of hypertension history at the 90-day follow-up (odds ratio [OR] with history, 1.11 [95% CI, 0.91-1.36]; OR without history, 1.38 [95% CI, 0.92-2.08]; Pfor interaction =.29).

Among patients without hypertension, early hypertensive treatment was associated with a higher modified Rankin Scale score (OR, 1.35; 95% CI, 1.01-1.82) according to the ordinal logistic regression. Among patients with hypertension, early hypertensive treatment was not associated with a higher modified Rankin Scale score (OR, 0.95; 95% CI, 0.82-1.10; Pfor interaction =.04).

Major vascular events, recurrent stroke, or death within 90 days (secondary outcomes), were not significantly different between treatment groups among patients with or without hypertension history (all Pfor interaction >.05).

Study limitations include limited generalizability.

“Early antihypertensive treatment did not reduce the odds of dependency or death at 90 days by hypertension history among patients with ischemic stroke but worsened functional outcomes for patients without hypertension in the ordinal analysis,” the investigators concluded and wrote, “These findings suggest that initiating antihypertensive treatment within the first week after ischemic stroke onset confers no significant benefit but even increases the risk of functional dependence for patients without prior hypertension.”

This article originally appeared on The Cardiology Advisor