{
  "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 anti-hypertensive 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.Trial registration number ClinicalTrials.gov identifier: NCT01840072.",
  "authors": [
    {
      "affiliations": [
        "Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Ming Wang"
    },
    {
      "affiliations": [
        "Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China",
        "The First Clinical Medical College, Nanjing Medical University, Nanjing, China"
      ],
      "name": "Shiguang Zhu"
    },
    {
      "affiliations": [
        "Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Jiayi Long"
    },
    {
      "affiliations": [
        "Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Mengyue Cao"
    },
    {
      "affiliations": [
        "North China University of Science and Technology Affiliated Hospital, Tangshan, Hebei, China"
      ],
      "name": "Yanbo Peng"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA",
        "Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA"
      ],
      "name": "Jing Chen"
    },
    {
      "affiliations": [
        "Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Tan Xu"
    },
    {
      "affiliations": [
        "Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA",
        "Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA"
      ],
      "name": "Jiang He"
    },
    {
      "affiliations": [
        "Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Yonghong Zhang"
    },
    {
      "affiliations": [
        "Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China"
      ],
      "name": "Chongke Zhong"
    }
  ],
  "title": "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",
  "uid": "d098f8cc-a9ea-5011-a997-f7261dc8f180"
}