Early versus delayed antihypertensive treatment in patients with acute ischaemic stroke: multicentre, open label, randomised, controlled trial

Methodology: 4/5
Usefulness: 2/5

Liu L, et al. BMJ. 2023 Oct 9;383:e076448.

Question: Do early vs delayed blood pressure management in patients with mild-moderate acute ischemic strokes decrease death or dependency at 90 days?
Methods: Randomization to early (24 hrs) vs delayed treatment (after 7 days) of blood pressure. They monitored BP at baseline, during admission and post discharge.
Findings: At 90 days, 12% of early treatment group vs 10.5% of delayed treatment group had primary composite outcome of death and dependency.
Limitations: They excluded important patients; severe strokes, atrial fibrillation, uncontrolled HTN at presentation. Blood pressure management prior to randomization (<24 hrs) was not accounted for.

Interpretation: This solidifies prior practice of allowing patients’ BP to auto-regulate. It is a reminder to treat uncontrolled hypertension in hemorrhagic strokes and patients undergoing intervention.

Dr. Pascale King

JC Supervisor: Dr. Vaillancourt

Authors

Pascale King

Dr. Pascale King is an Emergency Medicine resident in the Department of Emergency Medicine, University of Ottawa. She is a junior editor with the Digital Scholarship and Knowledge Dissemination team for the EMOttawaBlog.

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Hans Rosenberg

Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

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Christian Vaillancourt

Senior Scientist, Clinical Epidemiology Program Ottawa Hospital Research Institute Full Professor, Emergency Medicine University of Ottawa Research Chair in Emergency Cardiac Resuscitation, Emergency Medicine University of Ottawa Associate Medical Director, Regional Paramedic Program for Eastern Ontario Research Interests: Dr. Vaillancourt's current research program focuses on pre-hospital care, specifically improving care and survival for cardiac arrest and trauma victims.

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