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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2): rationale and design
Liping Liu1,2, Yilong Wang1,2, Xuewei Xie1,2
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Early blood pressure lowering in acute ischemic stroke patients may improve outcomes. The CATIS-2 trial investigates if immediate antihypertensive treatment reduces disability and mortality compared to delayed therapy.
Area of Science:
- Neurology
- Cardiology
- Clinical Trials
Background:
- Elevated blood pressure (BP) in acute ischemic stroke is linked to poor functional outcomes.
- The optimal timing for initiating antihypertensive therapy in these patients remains unclear.
Purpose of the Study:
- To compare the efficacy of early versus delayed antihypertensive treatment in acute ischemic stroke.
- To assess the impact on the composite endpoint of major disability and mortality at 3 months.
Main Methods:
- The China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2) is a multicenter, randomized, open-label, blinded-endpoints trial.
- Early treatment group: immediate antihypertensive therapy aiming for 10-20% systolic BP reduction in 24 hours and <140/90 mm Hg within 5 days.
- Delayed treatment group: antihypertensive medication withheld for 7 days, then initiated to achieve <140/90 mm Hg.
Main Results:
- Primary outcome: composite of death and major disability (modified Rankin Scale score ≥3) at 3 months post-randomization.
- Systolic blood pressure targets were defined for both early and delayed treatment groups.
Conclusions:
- The CATIS-2 trial will test hypotheses regarding early BP lowering and functional outcomes in acute ischemic stroke.
- Findings aim to inform clinical guidelines for BP management in this patient population.
Backgrounds:
Increased blood pressure (BP) for patients who had an acute ischaemic stroke is associated with poor functional outcome, however the optimal timing of antihypertensive therapy is unknown.
Aims:
We aim to compare early antihypertensive treatment to delayed antihypertensive treatment for reducing the risk of composite major disability and mortality at 3 months in acute ischaemic stroke.
Design:
The China Antihypertensive Trial in Acute Ischemic Stroke II (CATIS-2) trial is a multicentre, randomised, open-label, blinded-endpoints trial that will be conducted in 100 hospitals in China. The primary outcome is the composite of death and major disability (modified Rankin Scale score ≥3) at 3 months of randomisation. Antihypertensive treatment will be received immediately after randomisation in the early treatment group, aimed at average systolic BP by 10%-20% reduction within the first 24 hours, and achieving an average BP level of <140/90 mm Hg within 5 days. Patients in the delayed treatment group will discontinue any antihypertension medications for the first 7 days of randomisation, and will receive antihypertensive therapy achieving a BP goal of <140/90 mm Hg after 7 days.
Conclusion:
The CATIS-2 trial will be testing the hypotheses that early BP lowering leads to improved functional outcome without any other harms, and developing clinical guidelines of the BP management for patients who had an acute ischaemic stroke.
Trial Registration Number:
NCT03479554.
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