MedWire News: Reducing high blood pressure (BP) in patients with acute stroke does not appear to worsen their outcomes and may even reduce mortality, shows the CHHIPS trial, now published in The Lancet Neurology.
“The CHHIPS (Controlling Hypertension and Hypotension immediately Poststroke) investigators ambitiously sought to address an exceedingly important aspect of the management of acute stroke patients,” commented Sheryl Martin-Schild (Tulane University Hospital, New Orleans, Louisiana, USA) in an accompanying comment.
The management of BP in acute stroke patients is currently unclear. High BP is associated with poor outcomes, but intervention to reduce BP risks reduction of cerebral blood flow, further reducing perfusion of the ischemic area. Low BP in stroke patients is also associated with poor prognosis.
John Potter (University of East Anglia, Norwich, UK) and team intended to recruit 1650 patients with systolic (S)BP exceeding 160 mmHg to CHHIPS. However, the eligibility of many potential study participants for the concurrent Continue or Stop post-Stroke Antihypertensives Collaborative (COSSACS) study restricted recruitment to CHHIPS to 179 patients.
These patients (including 25 with primary hemorrhagic stroke) were randomly assigned to receive labetalol, lisinopril, or placebo within 36 hours of symptom onset. Patients were treated orally or intravenously as necessary, and drug doses were increased until patients reached a target SBP of 145–155 mmHg or a 15-mmHg SBP reduction.
Patients given active treatment achieved an average 21-mmHg fall in SBP, compared with an 11-mmHg fall in the placebo group. Despite this, patients in the active treatment group were no more likely to suffer neurologic deterioration than placebo-treated patients.
At 2 weeks after stroke, 61% of the active treatment group and 59% of the placebo group were dead or disabled. Adverse event rates were also similar between the two groups.
Actively treated patients were significantly less likely to die within 3 months, however, at 9.7% compared with 20.3% of the placebo group. But the researchers urge caution due to the small trial size and number of events.
“The study has contributed safety data and generated support for a larger prospective randomized study of BP lowering in acute stroke,” said Martin-Schild.
“Perhaps the increased risk for death that is associated with elevated BP in acute stroke can be modified. And perhaps patients who take these antihypertensives at the time of stroke should continue their home medications: an important point that the COSSACS study hopes to answer.”
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