Xiaoqing Bu1,2, Yonghong Zhang1, Lydia A Bazzano2, Tan Xu1, Libing Guo3, Xuemei Wang4, Jintao Zhang5, Yong Cui6, Dong Li7, Fengshan Zhang8, Zhong Ju9, Tian Xu1,2, Chung-Shiuan Chen2, Jing Chen2,10, Jiang He11,2,10. 1. School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China. 2. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA. 3. Department of Neurology, Siping Central Hospital, Jilin, China. 4. Department of Neurology, Jilin Central Hospital, Jilin, China. 5. Department of Neurology, The 88th Hospital of PLA, Shandong, China. 6. Department of Neurology, General Hospital of First Automobile Works, Jilin, China. 7. Department of Neurology, Feicheng City People's Hospital, Shandong, China. 8. Department of Neurology, Tongliao Municipal Hospital, Inner Mongolia, China. 9. Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China. 10. Department of Medicine, Tulane University School of Medicine, New Orleans, USA. 11. School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China jhe@tulane.edu.
Abstract
BACKGROUND: The effect of early blood pressure reduction on cognitive function in patients with acute ischemic stroke remains unknown. AIM: We tested whether antihypertensive treatment would reduce cognitive impairment in patients with acute ischemic stroke. METHODS: In the China Antihypertensive Trial in Acute Ischemic Stroke, patients with elevated blood pressure were randomly assigned to receive antihypertensive treatment or to discontinue all hypertensive medications within 48 h of onset. Cognitive function was measured by the Mini-Mental State Examination and Montreal Cognitive Assessment at 3 months after randomization in a subsample of 638 participants. RESULTS: Mean systolic blood pressure was reduced by 21.5 mmHg in the antihypertensive treatment group and 13.9 mmHg in the control group within 24 h after randomization (P < 0.001). Mean systolic blood pressure was 134.9 mmHg in the antihypertensive treatment group and 141.6 mmHg in the control group at day 14 after randomization (P < 0.001). Median Mini-Mental State Examination score was 26 and Montreal Cognitive Assessment score was 22 in both the antihypertensive treatment and control groups at 3 months. An Mini-Mental State Examination < 24 was present in 30.9% of patients in the antihypertensive treatment group compared with 29.7% in the control group (odds ratio = 1.06; 95% confidence interval 0.75-1.48; P = 0.75). Likewise, proportions of patients with Montreal Cognitive Assessment < 26 were similar between the antihypertensive treatment (70.6%) and control (70.7%) groups (odds ratio = 0.99; 95% confidence interval 0.70-1.40; P = 0.96). CONCLUSIONS: These data indicated that early blood pressure reduction with antihypertensive medication in patients with acute ischemic stroke had no effect on cognitive impairment at 3 months.
BACKGROUND: The effect of early blood pressure reduction on cognitive function in patients with acute ischemic stroke remains unknown. AIM: We tested whether antihypertensive treatment would reduce cognitive impairment in patients with acute ischemic stroke. METHODS: In the China Antihypertensive Trial in Acute Ischemic Stroke, patients with elevated blood pressure were randomly assigned to receive antihypertensive treatment or to discontinue all hypertensive medications within 48 h of onset. Cognitive function was measured by the Mini-Mental State Examination and Montreal Cognitive Assessment at 3 months after randomization in a subsample of 638 participants. RESULTS: Mean systolic blood pressure was reduced by 21.5 mmHg in the antihypertensive treatment group and 13.9 mmHg in the control group within 24 h after randomization (P < 0.001). Mean systolic blood pressure was 134.9 mmHg in the antihypertensive treatment group and 141.6 mmHg in the control group at day 14 after randomization (P < 0.001). Median Mini-Mental State Examination score was 26 and Montreal Cognitive Assessment score was 22 in both the antihypertensive treatment and control groups at 3 months. An Mini-Mental State Examination < 24 was present in 30.9% of patients in the antihypertensive treatment group compared with 29.7% in the control group (odds ratio = 1.06; 95% confidence interval 0.75-1.48; P = 0.75). Likewise, proportions of patients with Montreal Cognitive Assessment < 26 were similar between the antihypertensive treatment (70.6%) and control (70.7%) groups (odds ratio = 0.99; 95% confidence interval 0.70-1.40; P = 0.96). CONCLUSIONS: These data indicated that early blood pressure reduction with antihypertensive medication in patients with acute ischemic stroke had no effect on cognitive impairment at 3 months.
Authors: Lesly A Pearce; Leslie A McClure; David C Anderson; Claudia Jacova; Mukul Sharma; Robert G Hart; Oscar R Benavente Journal: Lancet Neurol Date: 2014-10-23 Impact factor: 44.182
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Authors: Ruth Peters; Nigel Beckett; Francoise Forette; Jaakko Tuomilehto; Robert Clarke; Craig Ritchie; Adam Waldman; Ivan Walton; Ruth Poulter; Shuping Ma; Marius Comsa; Lisa Burch; Astrid Fletcher; Christopher Bulpitt Journal: Lancet Neurol Date: 2008-07-07 Impact factor: 44.182