Controlling hypertension and hypotension immediately post stroke (CHHIPS)--a randomised controlled trial

Area of Science:

• Neurology
• Cardiology
• Clinical Trials

Background:

• Acute stroke management often involves blood pressure (BP) manipulation.
• The safety and efficacy of early BP interventions require further evaluation.

Purpose of the Study:

• To assess the impact of acute blood pressure (BP) manipulation on 2-week mortality and dependency in stroke patients.
• To investigate the safety and efficacy of pressor and depressor BP treatments in acute stroke.

Main Methods:

• A multicentre, prospective, randomized, double-blind, placebo-controlled trial.
• Patients with acute stroke (hypertensive or hypotensive) were randomized to active treatment or placebo.
• Primary endpoint: death and dependency at 2 weeks; secondary endpoints: safety, stroke type influence, route of administration, timing, and cost-effectiveness.

Main Results:

• No significant difference in 2-week death or dependency between active treatment and placebo groups.
• Active treatment led to greater BP reduction without increasing early neurological deterioration.
• Survival analysis indicated lower 3-month mortality in the active treatment group (p=0.05).
• The pressor arm was discontinued due to recruitment issues.

Conclusions:

• Lisinopril and labetalol effectively lower BP in acute stroke without increasing neurological deterioration.
• The study lacked power to detect 2-week differences in death/dependency.
• A 3-month mortality benefit in favor of active treatment warrants further research, alongside optimal timing and drug comparisons.