Early BP-lowering treatment poses harm in certain patients with stroke

Early initiation of blood pressure (BP)-lowering therapy is linked to a heightened risk of functional dependency or death among patients with single subcortical infarction (SSI) and coexisting parent artery disease (PAD) stenosis, as shown in a study.

Researchers conducted a secondary analysis of the CATIS-2 randomized clinical trial, which involved patients with acute ischaemic stroke within 24 to 48 hours of symptoms onset and elevated systolic BP. The secondary analysis included 997 patients with SSI (mean age 62.4 years, 61.4 percent male), as detected in diffusion-weighted imaging, who were divided into two groups based on the presence of PAD stenosis (yes: 11.6 percent; no: 88.4 percent).

Patients were randomly assigned to receive early (immediate) or delayed (initiated on day 8) antihypertensive therapy. The primary endpoint was the combination of functional dependency or death (modified Rankin Scale score ≥3) at 90 days.

Among all patients with SSI, those in the early treatment group were not more likely to have functional dependency or die within 90 days after randomization when compared with those in the delayed treatment group (8.8 percent vs 7.1 percent, respectively; odds ratio [OR], 1.25, 95 percent confidence interval [CI], 0.79–1.99; p=0.34).

However, in the subgroup of patients with PAD stenosis, early antihypertensive treatment was significantly associated with greater odds of the primary endpoint (23.4 percent vs 7.7 percent; OR, 3.67, 95 percent CI, 1.14–11.86; p=0.03). This association was not observed in the subgroup of patients without PAD stenosis (6.6 percent vs 7.1 percent; OR, 0.93, 95 percent CI, 0.55–1.57; p=0.77).

A significant interaction was observed between the treatment and the presence of PAD stenosis (p=0.04).