Effect of Immediate Antihypertensive Treatment on Clinical Outcomes in Acute Ischemic Stroke Patients With Different Renal Function Status

Abstract

Background: It remains unclear whether different blood pressure management strategies should be administered for acute stroke patients with or without impaired renal function. We conducted a secondary analysis of the CATIS trial (China Antihypertensive Trial in Acute Ischemic Stroke) to investigate the effect of early antihypertensive treatment among patients with acute ischemic stroke according to the baseline renal function assessed by estimated glomerular filtration rates (eGFR). Methods: The CATIS trial randomly assigned 4071 acute ischemic stroke patients with systolic blood pressure between 140 and 220 mm Hg to receive antihypertensive treatment or to discontinue all antihypertensive medications during hospitalization. A primary outcome (composite outcome of death and major disability) and secondary outcomes were compared between antihypertensive treatment and control groups by baseline renal function levels of eGFR values of <60, 60 to 89, and ≥90 mL/min per 1.73 m 2 . Results: At day 14 or hospital discharge, the primary outcome was not significantly different between the antihypertensive treatment and control groups in each subgroup stratified by renal function status ( P =0.98 for homogeneity), and the odds ratios (95% CIs) were 1.23 (0.76–2.02) in patients with eGFR <60 mL/min per 1.73 m 2 , 0.94 (0.75–1.19) in patients with eGFR values of 60–89 mL/min per 1.73 m 2 , and 1.04 (0.88–1.24) in patients with eGFR ≥90 mL/min per 1.73 m 2 , respectively. In addition, early antihypertensive treatment was not associated with secondary clinical outcomes by baseline renal function ( P >0.05 for all homogeneity). Conclusions: Early antihypertensive treatment had a neutral effect on clinical outcomes in ischemic stroke patients with different renal function status. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT01840072.