Efficacy of immediate anti-hypertensive treatment in patients with acute ischaemic stroke - a secondary analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial

Q: What were the main findings regarding outcomes across MAP and PP levels?

No significant difference was found for the primary outcome across MAP and PP tertiles, and early antihypertensive intervention also showed no association with secondary outcomes (including neurological deterioration, recurrent stroke, vascular events, and all-cause mortality).

Sep 29, 2026

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Mean arterial pressure (MAP) and pulse pressure (PP) reflect cerebral perfusion, but their usefulness for guiding antihypertensive selection after acute ischaemic stroke is unclear. This secondary analysis evaluates whether early antihypertensive intervention changes adverse clinical outcomes when patients are stratified by tertiles of MAP and PP within the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The analysis compares BP-lowering versus discontinuation strategies and assesses death or major disability and multiple secondary outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

Stroke burden and hypertension

Evidence from prior trials

Rationale for MAP and PP

Open access Original research To cite: Wang M, Zhu S, Long J, et al. Efficacy of immediate anti-hypertensive treatment inpatients with acute ischaemic stroke stratified by mean arterial pressure and pulse pressure: a secondary analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial. Stroke & Vascular Neurology 2025;0 . doi:10.1136/svn-2024-003896 ► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi.org/10.1136/](https://doi.org/10.1136/)[ ](https://doi.org/10.1136/)[svn-2024-003896](svn-2024-003896)) . MW and SZ contributed equally. Received 20 November 2024 Accepted 9 April 2025 © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. For numbered affiliations see end of article. Correspondence to Dr Chongke Zhong; [ckzhong@suda.edu.cn](ckzhong@suda.edu.cn) Efficacy of immediate anti-hypertensive treatment in patients with acute ischaemic stroke stratified by mean arterial pressure and pulse pressure: a secondary analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial Ming Wang ,1 Shiguang Zhu,2,3 Jiayi Long,1 Mengyue Cao,1 Yanbo Peng,4 Jing Chen,5,6 Tan Xu,1 Jiang He,5,6 Yonghong Zhang,1 Chongke Zhong 1 ABSTRACT Background Whether mean arterial pressure (MAP) and pulse pressure (PP), two indicators of cerebral perfusion, could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain. Our study was to explore the impact of early anti-hypertensive intervention on adverse clinical outcomes following ischaemic stroke stratified by the levels of MAP and PP based on the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) . Methods The trial randomised 4071 acute ischaemic stroke patients with elevated systolic blood pressure (SBP) to receive anti-hypertensive treatment (targeting a 10%–25% reduction in SBP during the 24 hours postrandomisation, reaching a BP level <140/90 mm Hg in 7 days, further keeping these levels throughout hospitalisation) or discontinue anti-hypertensive treatment during hospitalisation. The primary outcome was death or major disability at 14 days or hospital discharge. Study outcomes were analysed by comparing the BP-lowering intervention group and control group, stratified by tertiles of MAP or PP levels. Results No significant difference was observed in the primary outcome between the intervention and control groups across all MAP (p=0 .69 for homogeneity) and PP (p=0 .78 for homogeneity) categories. The corresponding odds ratios (95% CIs) were 1.08 (0 .85–1.36), 0.92 (0 .74–1. 15) and 1.00 (0 .81–1.25) for participants with low, intermediate, and high MAP and were 0.99 (0 .79–1.25), 1.06 (0 .84–1.34) and 0.95 (0 .77–1. 18) for participants in PP subgroups, respectively. Furthermore, early antihypertensive intervention was not associated with secondary outcomes (including neurological deterioration, recurrent stroke, vascular events and all-cause mortality) by MAP and PP (all p>0 .05) . Conclusions Early anti-hypertensive therapy neither decreased nor increased the odds of major disability, mortality, recurrent stroke or vascular events in patients with acute ischaemic stroke regardless of different MAP and PP levels. WHAT IS ALREADY KNOWN ON THIS TOPIC | ⇒ Existed trials had yielded inconsistent effects of antihypertensive treatment on adverse outcomes after acute ischaemic stroke. Whether mean arterial pressure (MAP) and pulse pressure (PP), two indicators of cerebral perfusion, could guide the selection of anti-hypertensive strategies after acute ischaemic stroke remains uncertain.
WHAT THIS STUDY ADDS | | --- | | ⇒ In this subgroup analysis of the China Antihypertensive Trial in Acute Ischemic Stroke, early anti-hypertensive treatment had a neutral impact on clinical outcomes among acute ischaemic stroke patients with va

FAQs

What question does the study address about MAP and PP?

It tests whether mean arterial pressure (MAP) and pulse pressure (PP) can guide antihypertensive strategy selection after acute ischaemic stroke, a topic described as still uncertain.

How was early antihypertensive treatment implemented in the CATIS trial analysis?

Patients were randomized to receive antihypertensive treatment targeting a 10%–25% SBP reduction within 24 hours, aiming for <140/90 mm Hg by 7 days, or to discontinue antihypertensive treatment during hospitalization.

What were the main findings regarding outcomes across MAP and PP levels?

No significant difference was found for the primary outcome across MAP and PP tertiles, and early antihypertensive intervention also showed no association with secondary outcomes (including neurological deterioration, recurrent stroke, vascular events, and all-cause mortality).

Sep 29, 2026

Uploaded by ahduag