■中国急性缺血性卒中II(CATIS-2)抗高血压试验表明,早期抗高血压治疗并未降低急性缺血性卒中(AIS)的依赖性或死亡风险,与延迟治疗相比。单发皮质下梗死(SSI)是一种重要的卒中亚型,降压时机与临床结局的关联尚不清楚.
为了研究早期和延迟降压治疗与SSI患者临床结局的关系,根据母体动脉疾病(PAD)狭窄的存在进行分层。
■对CATIS-2随机临床试验的二次分析包括2018年6月至2022年7月在中国的106家医院。在CATIS-2中,在症状发作后24至48小时内患有AIS且收缩压升高的患者是合格的。在弥散加权成像中检测到的SSI患者被纳入当前的事后亚组分析。患者分为(1)有PAD狭窄的SSI和(2)无PAD狭窄的SSI。从2023年7月至2024年5月进行统计分析。
■早期(立即)与延迟(从第8天开始)抗高血压治疗。
■主要结果是90天功能依赖或死亡(改良Rankin量表评分≥3)的组合。
■在CATIS-2中的997例SSI患者中(平均[SD]年龄,62.4[9.8]岁;男性612[61.4%]),116例(11.6%)有有PAD的SSI,881例(88.4%)无PAD的SSI。在所有SSI患者中,早期和延迟降压治疗组之间的主要结局没有显着差异(8.8%vs7.1%;OR,1.25[95%CI,0.79-1.99];P=.34)。在患有SSI伴PAD的患者中,与延迟治疗相比,早期抗高血压治疗与主要结局风险增加相关(23.4%vs7.7%;OR,3.67[95%CI,1.14-11.86];P=.03);在没有PAD的SSI患者中未观察到这一发现(6.6%vs7.1%;OR,0.93[95%CI,0.55-1.57];P=.77)。对于主要结果,检测到与治疗和存在PAD狭窄的显着相互作用(相互作用的P=.04)。
■在这项随机临床试验的二次分析中,早期抗高血压治疗与SSI和共存PAD狭窄患者90天功能依赖性或死亡风险增加相关,与延迟降压治疗相比。对于存在PAD的SSI患者的个体化BP管理,需要进一步的研究。
■ClinicalTrials.gov标识符:NCT03479554。
UNASSIGNED: The China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2) suggests that early antihypertensive treatment did not reduce the risk of dependency or death in acute ischemic stroke (AIS), compared with delayed treatment. Single subcortical infarction (SSI) is an important stroke subtype, and the association of antihypertensive timing with clinical outcomes is unclear.
UNASSIGNED: To investigate the association of early vs delayed antihypertensive treatment with clinical outcomes in patients with SSI, stratified by the presence of parent artery disease (PAD) stenosis.
UNASSIGNED: This secondary analysis of the CATIS-2 randomized clinical trial included 106 hospitals in China between June 2018 and July 2022. In CATIS-2, patients with AIS within 24 to 48 hours of symptoms onset and elevated systolic blood pressure were eligible. Patients with SSI detected in diffusion-weighted imaging were included in the current post hoc subgroup analysis. Patients were grouped into (1) SSI with PAD stenosis and (2) SSI without PAD stenosis. Statistical analysis was performed from July 2023 to May 2024.
UNASSIGNED: Early (immediate) vs delayed (starting on day 8) antihypertensive therapy.
UNASSIGNED: Primary outcome was the combination of functional dependency or death (modified Rankin Scale score ≥3) at 90 days.
UNASSIGNED: Among 997 patients with SSI in CATIS-2 (mean [SD] age, 62.4 [9.8] years; 612 [61.4%] men), 116 (11.6%) had SSI with PAD and 881 (88.4%) had SSI without PAD. There was no significant difference in the primary outcome between early and delayed antihypertensive treatment groups among all patients with SSI (8.8% vs 7.1%; OR, 1.25 [95% CI, 0.79-1.99]; P = .34). Among patients with SSI with PAD, early antihypertensive treatment was associated with increased risk of the primary outcome compared with delayed treatment (23.4% vs 7.7%; OR, 3.67 [95% CI, 1.14-11.86]; P = .03); this finding was not observed in patients with SSI without PAD (6.6% vs 7.1%; OR, 0.93 [95% CI, 0.55-1.57]; P = .77). Significant interaction with treatment and presence of PAD stenosis was detected for the primary outcome (P for interaction = .04).
UNASSIGNED: In this secondary analysis of a randomized clinical trial, early antihypertensive treatment was associated with an increased risk of functional dependency or death at 90 days among patients with SSI and coexisting PAD stenosis, compared with delayed antihypertensive treatment. Further studies are warranted for individualized BP management in patients with SSI by the presence of PAD.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT03479554.