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作者

He, J. Zhang, Y. Xu, T. Zhao, Q. Wang, D. Chen, C.-S. Tong, W. Liu, C. Ju, Z. Peng, Y. Peng, H. Li, Q. Geng, D. Zhang, J. Li, D. Zhang, F. Guo, L. Sun, Y. Wang, X. Cui, Y. Li, Y. Ma, D. Yang, G. Gao, Y. Yuan, X. Bazzano, L.A. Chen, J.

作者单位

Department of Neurology, Hebei United University, Hebei, China f Department of Neurology, Yutian County Hospital, Hebei, China m Department of Neurology, Siping Central Hospital, Jilin, China Tulane Hypertension and Renal Center of Excellence, New Orleans, LA, United States g Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China Department of Epidemiology, Tulane University, School of Public Health and Tropical Medicine, 1440 Canal St, Ste 2000, New Orleans, LA 70112, United States i Department of Neurology, Xuzhou Medical College, Jiangsu, China l Department of Neurology, Tongliao Municipal Hospital, Inner Mongolia, China s Department of Neurology, Second People's Hospital of Huaian City, Jiangsu, China q Department of Neurology, Tangshan Worker's Hospital, Hebei, China u Department of Neurology, Kailuan General Hospital, Hebei, China k Department of Internal Medicine, Feicheng City People's Hospital, Shandong, China r Department of Neurology, Jilin University, Jilin, China n Department of Cardiology, China Medical University, Liaoning, China p Department of Neurology, General Hospital of First Automobile Works, Jilin, China o Department of Neurology, Jilin Central Hospital, Jilin, China Department of Medicine, Tulane University, School of Medicine, New Orleans, LA, United States j Department of Neurology, 88th Hospital of PLA, Shandong, China t Department of Neurology, Chengde Medical College, Hebei, China h Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China a Department of Epidemiology, School of Public Health, Soochow University, 199 Renai Rd, Suzhou 215123, 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 si...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 were randomly assigned to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization . MAIN OUTCOMES AND MEASURES: Primary outcome was a combination of death and major disability at 14 days or hospital discharge. RESULTS: Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg in the control group within 24 hours after randomization . 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 . The primary outcome did not differ between treatment groups 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 . 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01840072.收起

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