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作者

He, J Zhang, YH Xu, T Zhao, Q Wang, DL Chen, CS Tong, WJ Liu, CJ Ju, Z

作者单位

Hebei United Univ, Dept Neurol, Affiliated Hosp, Tangshan, Hebei, Peoples R China Yutian Cty Hosp, Dept Neurol, Xinjiang, Hebei, Peoples R China Tulane Univ, Dept Med, Sch Med, New Orleans, LA 70112 USA Tulane Univ, Sch Publ Hlth & Trop Med, Dept Epidemiol, New Orleans, LA 70112 USA Xuzhou Med Coll, Dept Neurol, Affiliated Hosp, Xuzhou, Jiangsu, Peoples R China [ 10 ] Feicheng City Peoples Hosp, Dept Internal Med, Tai An, Shandong, Peoples R China [ 11 ] Tongliao Municipal Hosp, Dept Neurol, Tongliao, Inner Mongolia, Peoples R China [ 12 ] Siping Cent Hosp, Dept Neurol, Siping, Jilin, Peoples R China [ 13 ] China Med Univ, Affiliated Hosp 1, Dept Cardiol, Liaoning, Peoples R China [ 14 ] Jilin Cent Hosp, Dept Neurol, Changchun, Jilin, Peoples R China [ 15 ] First Automobile Works, Dept Neurol, Gen Hosp, Changchun, Jilin, Peoples R China [ 16 ] Tangshan Workers Hosp, Dept Neurol, Tangshan, Hebei, Peoples R China [ 17 ] Jilin Univ, Dept Neurol, Affiliated Hosp 1, Changchun, Jilin, Peoples R China [ 18 ] Second Peoples Hosp Huaian City, Dept Neurol, Huaian, Jiangsu, Peoples R China [ 19 ] Chengde Med Coll, Dept Neurol, Affiliated Hosp, Chengde, Hebei, Peoples R China [ 20 ] Kailuan Gen Hosp, Dept Neurol, Tangshan, Hebei, Peoples R China Tulane Hypertens & Renal Ctr Excellence, New Orleans, LA USA Taishan Med Coll, Dept Epidemiol, Sch Publ Hlth, Tai An, Shandong, Peoples R China Soochow Univ, Dept Epidemiol, Sch Publ Hlth, Coll Med, Suzhou 215123, Peoples R China Kerqin Dist First Peoples Hosp Tongliao City, Dept Neurol, Tongliao City, Inner Mongolia, Peoples R China

刊名

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

年份

2014

卷号

Vol.311 No.5

页码

479-489

ISSN

0098-7484

摘要

IMPORTANCE Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain. OBJECTIVE To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge. DESIGN, SETTING, AND PARTICIPANTS The China Antihypertensive Trial in Acute Ischemic Stroke, a singl...更多

IMPORTANCE Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain. OBJECTIVE To evaluate whether immediate blood pressure reduction in patients with acute ischemic stroke would reduce death and major disability at 14 days or hospital discharge. DESIGN, SETTING, AND PARTICIPANTS The China Antihypertensive Trial in Acute Ischemic Stroke, a single-blind, blinded end-points randomized clinical trial, conducted among 4071 patients with nonthrombolysed ischemic stroke within 48 hours of onset and elevated systolic blood pressure. Patients were recruited from 26 hospitals across China between August 2009 and May 2013. INTERVENTIONS Patients (n = 2038) were randomly assigned to receive antihypertensive treatment (aimed at lowering systolic blood pressure by 10% to 25% within the first 24 hours after randomization, achieving blood pressure less than 140/90 mm Hg within 7 days, and maintaining this level during hospitalization) or to discontinue all antihypertensive medications (control) during hospitalization (n = 2033). MAIN OUTCOMES AND MEASURES Primary outcome was a combination of death and major disability (modified Rankin Scale score >= 3) at 14 days or hospital discharge. RESULTS Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg (-12.7%) within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg (-7.2%) in the control group within 24 hours after randomization (difference, -5.5%[95% CI, -4.9 to -6.1%]; absolute difference, -9.1 mm Hg [95% CI, -10.2 to -8.1]; P < .001). Mean systolic blood pressure was 137.3 mm Hg in the antihypertensive treatment group and 146.5 mm Hg in the control group at day 7 after randomization (difference, -9.3 mm Hg [95% CI, -10.1 to -8.4]; P < .001). The primary outcome did not differ between treatment groups (683 events [antihypertensive treatment] vs 681 events [control]; odds ratio, 1.00 [95% CI, 0.88 to 1.14]; P = .98) at 14 days or hospital discharge. The secondary composite outcome of death and major disability at 3-month posttreatment follow-up did not differ between treatment groups (500 events [antihypertensive treatment] vs 502 events [control]; odds ratio, 0.99 [95% CI, 0.86 to 1.15]; P = .93). CONCLUSION AND RELEVANCE 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.收起

学科

【SCI学科】MEDICINE, GENERAL & INTERNAL 【ESI学科】CLINICAL MEDICINE

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