Intensive Blood Pressure Control After Stroke Harms More Than Helps

Intensive blood pressure control following endovascular thrombectomy for acute ischemic stroke due to intracranial large-vessel occlusion undermines the functional recovery of patients, according to new research published in The Lancet.

Trial findings were so significant that the study was stopped early due to “persistent efficacy and safety concerns.”

“Our study provides a strong indication that this increasingly common treatment strategy should now be avoided in clinical practice, said corresponding author Craig Anderson, MBBS, PhD, director, Global Brain Health, The George Institute for Global Health in Newton, New South Wales, Australia.

News: Incidents of Subarachnoid Hemorrhage on the Rise, Especially in Black Americans

Intensive blood pressure control has become a widely used strategy to try to avoid reperfusion injury following endovascular thrombectomy. As Anderson and co-authors indicated, however, the practice was adopted “without evidence to support the benefits versus potential harms.”

The researchers conducted an open-label, blinded-endpoint, randomized controlled trial at 44 tertiary-level hospitals in China. A total of 821 patients who had persistently elevated systolic blood pressure (³140 mm Hg for >10min) following stroke treatment were randomly assigned to more intensive treatment (systolic blood pressure target <120 mm Hg; n=407) or less intensive treatment (target 140-180 mm Hg; n=404), achieved within 1 hour and sustained for 72 hours. The primary efficacy outcome was functional recovery assessed according to the modified Rankin scale at 90 days.

Outcome data showed that there was a greater chance of poor functional outcome among the more intensive treatment group, including early neurological deterioration and major disability at 90 days, than the less intensive treatment group. No significant differences in symptomatic intracerebral hemorrhage, serious adverse effects, or mortality were found between the groups.

References

Yang P, Song L, Zhang Y, et al. Intensive blood pressure control after endovascular thrombectomy for acute ishaemic stroke (ENCHANTED2/MT): A multicentre, open-label, blinded-endpoint, randomized controlled trial. Lancet. Published online October 27, 2022.

Large stroke trial finds intensive blood pressure lowering after clot removal worsens recovery. News release. George Institute for Global Health. October 28, 2022. Accessed November 1, 2022.