Controlling Hypertension After Stroke Cut the Risk Of Mortality at 3 Months

NEW ORLEANS — Treatment of dangerously high blood pressure in the period immediately following an acute stroke was associated with significantly reduced 3-month mortality in the randomized, placebo-controlled Control of Hypertension and Hypotension Immediately Post-Stroke trial.

Patients in the CHHIPS pilot trial did not immediately benefit from antihypertensive medications because the trial's primary end point—the rate of death and dependency at 2 weeks after the stroke—was no different between treated and placebo patients, even though the patients who received antihypertensive drugs had significantly greater decline in systolic blood pressure (SBP) within the first 24 hours than did those who received placebo, Dr. John Potter reported at International Stroke Conference 2008.

“We know that elevated blood pressure levels are important in predicting primary and secondary [stroke] prevention, but we don't know much about the relationship in the acute situation,” said Dr. Potter of the University of East Anglia, Norwich, England.

Dr. Potter and his colleagues randomized 179 patients older than 18 years with a stroke onset within 36 hours and stroke symptoms lasting more than 60 minutes.

Patients who could swallow oral medications received 5 mg lisinopril, 50 mg labetalol, or oral placebo. If after 4 hours, their SBP had not dropped to a target range of 145–155 mm Hg or decreased by at least 15%, then the investigators gave another round of the same doses. If necessary, this was repeated at 8 hours if necessary. During the next 13 days, patients received 5–15 mg lisinopril, 50–150 mg labetalol, or placebo.

For dysphagic patients, the investigators combined sublingual lisinopril with an intravenous placebo, oral labetalol with sublingual placebo, or sublingual and intravenous placebos. Between days 1 and 5, dysphagic patients were switched to oral medications or received their medications through a nasogastric or percutaneous endoscopic gastrostomy tube.

Although the active treatment groups had a significantly greater mean decline in SBP than did placebo-treated patients within the first 24 hours (21 mm Hg vs. 11 mm Hg) and at 2 weeks (31 mm Hg vs. 24 mm Hg), there was no difference between the treatment groups in the rate of death and dependency at 2 weeks (61% vs. 59%).

Patients who received labetalol or lisinopril reached the target SBP outcomes in significantly higher proportions than did placebo-treated patients at 4 and 8 hours after stroke, but not at 24 hours. There were no differences in neurological status between the groups at 72 hours. However, patients who received placebo had a 2.2 times higher risk of dying by 3 months than did actively treated patients, Dr. Potter said at the conference, which was sponsored by the American Stroke Association.

NEW ORLEANS — Treatment of dangerously high blood pressure in the period immediately following an acute stroke was associated with significantly reduced 3-month mortality in the randomized, placebo-controlled Control of Hypertension and Hypotension Immediately Post-Stroke trial.

Patients in the CHHIPS pilot trial did not immediately benefit from antihypertensive medications because the trial's primary end point—the rate of death and dependency at 2 weeks after the stroke—was no different between treated and placebo patients, even though the patients who received antihypertensive drugs had significantly greater decline in systolic blood pressure (SBP) within the first 24 hours than did those who received placebo, Dr. John Potter reported at International Stroke Conference 2008.

“We know that elevated blood pressure levels are important in predicting primary and secondary [stroke] prevention, but we don't know much about the relationship in the acute situation,” said Dr. Potter of the University of East Anglia, Norwich, England.

Dr. Potter and his colleagues randomized 179 patients older than 18 years with a stroke onset within 36 hours and stroke symptoms lasting more than 60 minutes.

Patients who could swallow oral medications received 5 mg lisinopril, 50 mg labetalol, or oral placebo. If after 4 hours, their SBP had not dropped to a target range of 145–155 mm Hg or decreased by at least 15%, then the investigators gave another round of the same doses. If necessary, this was repeated at 8 hours if necessary. During the next 13 days, patients received 5–15 mg lisinopril, 50–150 mg labetalol, or placebo.

For dysphagic patients, the investigators combined sublingual lisinopril with an intravenous placebo, oral labetalol with sublingual placebo, or sublingual and intravenous placebos. Between days 1 and 5, dysphagic patients were switched to oral medications or received their medications through a nasogastric or percutaneous endoscopic gastrostomy tube.

Although the active treatment groups had a significantly greater mean decline in SBP than did placebo-treated patients within the first 24 hours (21 mm Hg vs. 11 mm Hg) and at 2 weeks (31 mm Hg vs. 24 mm Hg), there was no difference between the treatment groups in the rate of death and dependency at 2 weeks (61% vs. 59%).

Patients who received labetalol or lisinopril reached the target SBP outcomes in significantly higher proportions than did placebo-treated patients at 4 and 8 hours after stroke, but not at 24 hours. There were no differences in neurological status between the groups at 72 hours. However, patients who received placebo had a 2.2 times higher risk of dying by 3 months than did actively treated patients, Dr. Potter said at the conference, which was sponsored by the American Stroke Association.

NEW ORLEANS — Treatment of dangerously high blood pressure in the period immediately following an acute stroke was associated with significantly reduced 3-month mortality in the randomized, placebo-controlled Control of Hypertension and Hypotension Immediately Post-Stroke trial.

Patients in the CHHIPS pilot trial did not immediately benefit from antihypertensive medications because the trial's primary end point—the rate of death and dependency at 2 weeks after the stroke—was no different between treated and placebo patients, even though the patients who received antihypertensive drugs had significantly greater decline in systolic blood pressure (SBP) within the first 24 hours than did those who received placebo, Dr. John Potter reported at International Stroke Conference 2008.

“We know that elevated blood pressure levels are important in predicting primary and secondary [stroke] prevention, but we don't know much about the relationship in the acute situation,” said Dr. Potter of the University of East Anglia, Norwich, England.

Dr. Potter and his colleagues randomized 179 patients older than 18 years with a stroke onset within 36 hours and stroke symptoms lasting more than 60 minutes.

Patients who could swallow oral medications received 5 mg lisinopril, 50 mg labetalol, or oral placebo. If after 4 hours, their SBP had not dropped to a target range of 145–155 mm Hg or decreased by at least 15%, then the investigators gave another round of the same doses. If necessary, this was repeated at 8 hours if necessary. During the next 13 days, patients received 5–15 mg lisinopril, 50–150 mg labetalol, or placebo.

For dysphagic patients, the investigators combined sublingual lisinopril with an intravenous placebo, oral labetalol with sublingual placebo, or sublingual and intravenous placebos. Between days 1 and 5, dysphagic patients were switched to oral medications or received their medications through a nasogastric or percutaneous endoscopic gastrostomy tube.

Although the active treatment groups had a significantly greater mean decline in SBP than did placebo-treated patients within the first 24 hours (21 mm Hg vs. 11 mm Hg) and at 2 weeks (31 mm Hg vs. 24 mm Hg), there was no difference between the treatment groups in the rate of death and dependency at 2 weeks (61% vs. 59%).

Patients who received labetalol or lisinopril reached the target SBP outcomes in significantly higher proportions than did placebo-treated patients at 4 and 8 hours after stroke, but not at 24 hours. There were no differences in neurological status between the groups at 72 hours. However, patients who received placebo had a 2.2 times higher risk of dying by 3 months than did actively treated patients, Dr. Potter said at the conference, which was sponsored by the American Stroke Association.