Antihypertensive Treatments After Acute Ischemic Stroke: to Continue or Not?

BACKGROUND: How to manage existing antihypertensive treatment is a common clinical dilemma after acute ischemic stroke; whether such treatment should be continued immediately or delayed remains unclear. METHODS: We performed prespecified subgroup analyses of the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) and CATIS-2 (China Antihypertensive Trial in Acute Ischemic Stroke II). The CATIS randomly assigned 4071 patients with acute ischemic stroke to receive immediate or discontinued antihypertensive treatment during hospitalization. The CATIS-2 randomized 4810 patients to early (within 24–48 hours) or delayed antihypertensive treatment (reinitiated on day 8). The primary outcome was a combination of death or major disability (modified Rankin Scale score ≥3). RESULTS: A total of 1997 participants (49.1%) in CATIS and 2540 participants (52.9%) in CATIS-2 were taking antihypertensive medications at the time of stroke onset. Among those with existing antihypertensive use, immediate continuous versus no antihypertensive treatment in CATIS was not associated with decreased or increased odds of the primary outcome at 14 days or hospital discharge (odds ratio, 1.07 [95% CI, 0.89–1.29]). In CATIS-2, early versus delayed antihypertensive treatment did not demonstrate a significant association with the primary outcome at 90 days (odds ratio, 1.15 [95% CI, 0.89–1.48]). In addition, in participants without prior antihypertensive medication use, the study outcomes did not differ between the 2 comparison groups in either trial ( P interaction >0.05). CONCLUSIONS: Early continuation of antihypertensive treatment did not decrease or increase the odds of adverse clinical outcomes compared with no treatment or delayed treatment among patients with prestroke antihypertensive treatment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01840072 and NCT03479554.