Comparative effects of antihypertensive drugs on stroke outcome in China.

Abstract

BACKGROUND:

Antihypertensive drugs are useful in the prevention of stroke; however, much debate surrounds which class of agent provides the most benefit post-stroke.

AIMS:

The aim of this study was to examine the impact of different classes of antihypertensive agent on stroke outcome using data from the ChinaQUEST study, a prospective, hospital-based stroke registry undertaken across 62 hospitals in China.

METHODS:

Logistic regression analysis was used to determine the comparative associations of different antihypertensive medications when initiated in-hospital post-stroke on the following poor outcomes in stroke survivors at three- and 12 months post-stroke: (1) death and dependency, based on modified Rankin Scale scores 3-5; (2) death; and (3) dependency.

RESULTS:

Of the 6416 patients with baseline data, 3986 (62%) were on at least one antihypertensive agent. After adjustment for baseline characteristics and concomitant therapies, there were no differences in outcomes between therapies at three- and 12 months, but at 12 months, calcium channel blocker use was associated with reduced risks of death/dependency (odds ratio 0·78, P  = 0·001) and death (odds ratio 0·66, P < 0·001). In addition, angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist use was associated with reduced risk of death (odds ratio 0·76, P  = 0·009), whereas both beta-blockers and diuretics were shown to increase the risk of death/dependency and death but had no effect on the risk of dependency.

CONCLUSION:

This study suggests that early initiation of calcium channel blockers is associated with improved outcome after stroke. Further randomized studies are warranted to confirm these findings and to delineate differential beneficial effects of antihypertensive therapy in stroke prevention.

• Authors: Emma L Heeley, Jade W Wei, Ji-Guang Wang, Hisatomi Arima, Yining Huang, Lawrence K S Wong, Craig S Anderson, ChinaQUEST Investigators
• Journal: International journal of stroke : official journal of the International Stroke Society (Int J Stroke) Vol. 9 Suppl A100 Pg. 113-8 (Oct 2014) ISSN: 1747-4949 [Electronic] United States
• PMID: 25042450 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 World Stroke Organization.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Antihypertensive Agents
• Calcium Channel Blockers

Topics

• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Antihypertensive Agents (classification, therapeutic use)
• Calcium Channel Blockers (therapeutic use)
• China
• Databases, Factual (ethics)
• Female
• Humans
• Logistic Models
• Male
• Stroke (drug therapy, mortality)
• Survival Analysis
• Time Factors
• Treatment Outcome