Failure to Reduce High Blood Pressure After Endovascular Therapy Linked to Poorer Outcomes

February 14, 2022

By Nancy Melville

VIRTUAL -- February 14, 2022 -- Patients with acute ischaemic stroke and high blood (BP) pressure following successful endovascular therapy show poorer outcomes if blood pressure is not lowered soon after the procedure, according to a study presented at the 2022 International Stroke Conference (ISC).

“We found a linear relationship between systolic blood pressure change after successful reperfusion and poor outcome,” said Mohammad Anadani, MD, Medical University of South Carolina, Charleston, South Carolina.

The findings come from a post-hoc analysis of the BP TARGET trial, where patients with acute ischaemic stroke due to anterior circulation large vessel occlusion and systolic BP of at least 130 mm Hg at the end of their procedure were randomised to either intensive BP-lowering treatment (target of 100-129 mmHg within 1 hour) or standard treatment, with a target of 130 to 185 mm Hg. The current analysis included 267 patients. These patients had their BP measured every 15 minutes for 2 hours after randomisation, then every 30 minutes for 6 hours, and then every hour for the remaining 16 hours.

 At 90 days, patients with lower reductions in systolic BP at all time intervals had poorer outcomes, defined as modified Rankin Scale (mRS) scores of 3 to 6. 

After adjusting for potential confounders including baseline systolic BP, the reduction in systolic BP within the first hour post-procedure (at 15-60 minutes) was associated with reduced odds of worse outcomes (P = .024). Likewise, a reduction in systolic BP over 6 to 24 hours was associated with a lower risk of poor outcomes (P < .001).

In terms of safety, patients who experienced intraparenchymal haemorrhage (IPH) had lower reductions in systolic BP at all time points; however, there was no link between reductions in systolic BP and mortality or neurological deterioration at any time interval.

When looking at the role of the magnitude of BP reduction, a reduction of 20 mm Hg or more in the first hour of randomisation was associated with significantly lower odds of a poor outcome, compared with minimal BP reductions of <10 mmHg (adjusted odds ratio, 0.38).  

“Overall, the results show that the risk of poor outcome and intracerebral haemorrhage were higher with less systolic BP reduction after endovascular therapy,” Dr. Anadani concluded.

ISC is sponsored by the American Heart Association and the American Stroke Association.

[Presentation title: Magnitude of Blood Pressure Change After Endovascular Therapy and Outcomes: Insight From BP Target Trial. Abstract 38]