To the Editor The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) study reported that antihypertensive therapy immediately after an acute ischemic stroke did not reduce the likelihood of death or major disability compared with placebo.1 In the trial, the effects of antihypertensive therapy seemed to be time dependent.
Although the study revealed no effect of antihypertensive therapy when treatment was administered within the first day of stroke, blood pressure lowering was associated with a 27% reduction in the primary outcome among patients treated after 24 hours of stroke onset. This finding is in accordance with the results from the Acute Candesartan Cilexetil Therapy in Stroke Survivors (ACCESS) study,2 in which candesartan was administered an average of 30 hours after recognition of stroke symptoms. Did Dr He and colleagues1 perform a formal interaction test3 to verify this finding? This finding comes from a subgroup analysis and can only be considered hypothesis generating, requiring further testing in future trials.
Nikolaidou B, Lazaridis A, Doumas M. Antihypertensive Therapy After Acute Ischemic Stroke. JAMA. 2014;311(22):2333-2334. doi:10.1001/jama.2014.5161