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Effect of immediate blood pressure reduction on post-stroke depression in ischemic stroke patients: A substudy of
Zhengbao Zhu1, Daoxia Guo2, Mengyao Shi3
1Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America.
Insights
Early antihypertensive treatment did not affect the risk of post-stroke depression (PSD) in patients with acute ischemic stroke. This study investigated the impact of immediate blood pressure management on depression rates following stroke.
Area of Science:
- Neurology
- Cardiology
- Psychiatry
Background:
- Hypertension is a known risk factor for post-stroke depression (PSD).
- The impact of immediate antihypertensive treatment on PSD risk in acute ischemic stroke patients was previously unknown.
Purpose of the Study:
- To investigate the effect of early antihypertensive treatment on the risk of developing post-stroke depression (PSD).
Main Methods:
- A randomized clinical trial (CATIS) involving 642 patients with acute ischemic stroke and elevated systolic blood pressure.
- Patients were assigned to either antihypertensive treatment or a control group.
- Depression was assessed using the Hamilton Rating Scale for Depression at 3-month follow-up.
Main Results:
- Early antihypertensive treatment significantly reduced systolic blood pressure compared to the control group at 24 hours, 7 days, and 14 days.
- At 3 months, the incidence of PSD was 38.4% in the treatment group and 40.4% in the control group (OR, 0.92; P=0.59).
- Early antihypertensive treatment showed no significant effect on the risk of PSD.
Conclusions:
- Immediate antihypertensive treatment does not influence the risk of post-stroke depression (PSD) at 3 months in acute ischemic stroke patients with elevated blood pressure.
- Findings may be limited to the Chinese population studied.
Background:
Several prospective studies have identified that hypertension is an important risk factor of post-stroke depression (PSD). However, the effect of immediate antihypertensive treatment on the risk of PSD in patients with acute ischemic stroke remains unknown.
Methods:
In this prespecified depression substudy of the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomized clinical trial, a total of 642 patients with acute ischemic stroke within 48 h of onset and elevated systolic BP at 7 sites of CATIS were included. Patients were randomly assigned to receive antihypertensive treatment (n = 318) or to control group (n = 324). The primary outcome was depression (Hamilton Rating Scale for Depression score≥8) at 3-month posttreatment follow-up.
Results:
At 24 h after randomization, the mean systolic BP was reduced by 21.6 mm Hg (12.5%) in the treatment group and 13.9 mm Hg (7.9%) in the control group (difference, -7.7 mm Hg [95% CI, -10.2 to -5.2]; P<0.001). The mean systolic BP levels at 7 days (P<0.001) and 14 days (P<0.001) after randomization in treatment group were also significantly lower than those in control group. At 3-month posttreatment follow-up, 122 patients (38.4%) in antihypertensive treatment group and 131 patients (40.4%) in control group developed PSD (odds ratio, 0.92 [95% CI, 0.67 to 1.26]; P = 0.59).
Limitations:
All patients in the CATIS trial were Chinese, which might limit the generalizability of our findings to other populations.
Conclusions:
Early antihypertensive treatment had no effect on the risk of PSD at 3 months among patients with acute ischemic stroke and elevated BP.
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