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Associations of Early Systolic Blood Pressure Control and Outcome After Thrombolysis-Eligible Acute Ischemic Stroke: Results From the ENCHANTED Study

journal contribution
posted on 25.11.2021, 16:04 by Xia Wang, Jatinder S Minhas, Tom J Moullaali, Gian Luca Di Tanna, Richard I Lindley, Xiaoying Chen, Hisatomi Arima, Guofang Chen, Candice Delcourt, Philip M Bath, Joseph P Broderick, Andrew M Demchuk, Geoffrey A Donnan, Alice C Durham, Pablo M Lavados, Tsong-Hai Lee, Christopher Levi, Sheila O Martins, Veronica V Olavarria, Jeyaraj D Pandian, Mark W Parsons, Octavio M Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K Sharma, Federico Silva, Nguyen H Thang, Ji-Guang Wang, Mark Woodward, John Chalmers, Lili Song, Craig S Anderson, Thompson G Robinson
Background and Purpose: In thrombolysis-eligible patients with acute ischemic stroke, there is uncertainty over the most appropriate systolic blood pressure (SBP) lowering profile that provides an optimal balance of potential benefit (functional recovery) and harm (intracranial hemorrhage). We aimed to determine relationships of SBP parameters and outcomes in thrombolyzed acute ischemic stroke patients. Methods: Post hoc analyzes of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial-factorial trial of thrombolysis-eligible and treated acute ischemic stroke patients with high SBP (150–180 mm Hg) assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) alteplase and intensive (target SBP, 130–140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) treatment. All patients were followed up for functional status and serious adverse events to 90 days. Logistic regression models were used to analyze 3 SBP summary measures postrandomization: attained (mean), variability (SD) in 1–24 hours, and magnitude of reduction in 1 hour. The primary outcome was a favorable shift on the modified Rankin Scale. The key safety outcome was any intracranial hemorrhage. Results: Among 4511 included participants (mean age 67 years, 38% female, 65% Asian) lower attained SBP and smaller SBP variability were associated with favorable shift on the modified Rankin Scale (per 10 mm Hg increase: odds ratio, 0.76 [95% CI, 0.71–0.82], P <0.001 and 0.86 [95% CI, 0.76–0.98], P =0.025) respectively, but not for magnitude of SBP reduction (0.98, [0.93–1.04], P =0.564). Odds of intracranial hemorrhage was associated with higher attained SBP and greater SBP variability (1.18 [1.06–1.31], P =0.002 and 1.34 [1.11–1.62], P =0.002) but not with magnitude of SBP reduction (1.05 [0.98–1.14], P =0.184). Conclusions: Attaining early and consistent low levels in SBP <140 mm Hg, even as low as 110 to 120 mm Hg, over 24 hours is associated with better outcomes in thrombolyzed acute ischemic stroke patients. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01422616.

History

Citation

Stroke. 2021;0:STROKEAHA.121.034580

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

AM (Accepted Manuscript)

Published in

Stroke

Publisher

American Heart Association

issn

0039-2499

eissn

1524-4628

Acceptance date

21/06/2021

Copyright date

2021

Available date

28/04/2022

Language

en