Abstract DP052: Differential Outcomes Based on Antihypertensive Intensity and Blood Pressure Response After Endovascular Treatment: a Secondary Analysis of the IDENTIFY Trial

Background: Prognosis according to blood pressure response across different levels of antihypertensive intensity has not been fully characterized after successful endovascular treatment. Methods: This is a secondary analysis of the IDENTIFY trial (Early intensive blood pressure management after endovascular treatment in ischemic stroke), a multicenter randomized controlled trial that enrolled 383 patients with acute ischemic stroke who underwent successful endovascular thrombectomy within 6 hours, and randomly assigned them to receive intensive (target SBP <130 mm Hg) or standard (target SBP <180 mm Hg) blood pressure management. This secondary analysis included all 383 patients from the IDENTIFY trial’s intention-to-treat population. Patients were classified into four groups by intervention status and BP response: Intervention&Decrease (ID), Intervention&Non-Decrease (IND), Non-Intervention&Decrease (NID), and Non-Intervention&Non-Decrease (NIND). Intervention status was defined by: 1) randomization assignment (I R /NI R ); or 2) intravenous antihypertensive use within 24 hours post-EVT (I D /NI D ). BP decrease was defined by: 1) whether the mean SBP at 6-24 hours (MSBP 6-24h ) post-EVT decreased more than 10% from admission (D 10 /ND 10 ); or 2) occurrence of hypotension within 24 hours post-EVT (D H /ND H ). The primary classification used randomization assignment and MSBP 6-24h decrease. The primary outcome was unfavorable functional outcome (modified Rankin Scale 3-6) at 90 days. Registration: Unique identifier: ChiCTR2200057770. Results: Of 360 patients with complete BP recordings, the NI R D 10 group had the lowest unfavorable outcome rate (62.5%). The I R D 10 group had the second lowest rate and did not differ significantly from the NI R D 10 group (67.7%, OR 1.32; 95% CI, 0.77-2.26). Both the I R ND 10 group (77.8%, OR 3.80; 95% CI, 1.49-9.72) and the NI R ND 10 group (73.7%, OR 2.67; 95% CI, 1.30-5.52) showed significantly higher risk of unfavorable functional outcome compared to the NI R D 10 group. When comparing the I R D 10 group to the NI R ND 10 group, it did not lead to better outcome (OR 1.84; 95% CI, 0.88-3.86). Conclusions: Spontaneous BP decrease after successful recanalization was associated with better prognosis. However, there is no evidence supports intensive BP management after EVT regardless of post-procedural BP status. Spontaneous post-procedural BP decrease and artificially induced reduction are not equivalent in terms of prognostic implications.