• Jiang He, Yonghong Zhang, Tan Xu, Qi Zhao, Dali Wang, Chung-Shiuan Chen, Weijun Tong, Changjie Liu, Tian Xu, Zhong Ju, Yanbo Peng, Hao Peng, Qunwei Li, Deqin Geng, Jintao Zhang, Dong Li, Fengshan Zhang, Libing Guo, Yingxian Sun, Xuemei Wang, Yong Cui, Yongqiu Li, Dihui Ma, Guang Yang, Yanjun Gao, Xiaodong Yuan, Lydia A Bazzano, Jing Chen, and CATIS Investigators.
• Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China2Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana3Department of Medicine, Tulane Un.
• JAMA. 2014 Feb 5; 311 (5): 479489479-89.

ImportanceAlthough 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.ObjectiveTo 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 ParticipantsThe 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.InterventionsPatients (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 MeasuresPrimary outcome was a combination of death and major disability (modified Rankin Scale score ≥3) at 14 days or hospital discharge.ResultsMean 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 RelevanceAmong 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 Registrationclinicaltrials.gov Identifier: NCT01840072.

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