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Antihypertensive Treatments After Acute Ischemic Stroke: to Continue or Not?

Chongke Zhong1, Ming Wang1, Dacheng Liu2

  • 1Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, China (C.Z., Ming Wang, T.X., Y.Z.).

Hypertension (Dallas, Tex. : 1979)
|December 5, 2025
PubMed

Insights

Continuing antihypertensive treatment immediately after acute ischemic stroke did not alter outcomes in patients already on these medications. Early or delayed treatment initiation showed no significant difference in preventing death or major disability.

Area of Science:

  • Cardiology
  • Neurology
  • Clinical Trials

Background:

  • Managing antihypertensive treatment post-acute ischemic stroke presents a clinical challenge.
  • Uncertainty exists regarding the immediate continuation versus delayed initiation of antihypertensive therapy.

Purpose of the Study:

  • To evaluate the impact of continuing existing antihypertensive treatment in patients with acute ischemic stroke.
  • To compare immediate versus discontinued antihypertensive treatment (CATIS trial) and early versus delayed treatment (CATIS-2 trial).

Main Methods:

  • Subgroup analyses from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) and CATIS-2 were conducted.
  • CATIS: 4071 patients randomized to immediate or discontinued antihypertensive treatment.
  • CATIS-2: 4810 patients randomized to early (24-48 hours) or delayed (day 8) antihypertensive treatment.

Main Results:

  • In CATIS, immediate continuous antihypertensive treatment showed no significant difference in primary outcomes (death/major disability) compared to discontinuation.
  • In CATIS-2, early antihypertensive treatment initiation did not significantly differ from delayed initiation for the primary outcome.
  • Outcomes were similar between groups for patients not on antihypertensives prior to stroke.

Conclusions:

  • Early continuation of antihypertensive treatment does not significantly alter adverse clinical outcomes in patients with prestroke antihypertensive use.
  • Neither immediate nor early initiation of antihypertensive therapy demonstrated a benefit in this patient population.
Abstract

Keywords:
antihypertensive treatmentblood pressuredeathischemic strokemajor disability

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