Abstract Background and aims The optimal BP management in patients with acute ischemic stroke (AIS) due to large-vessel occlusion treated with successful endovascular treatment (EVT) is uncertain. We aimed to assess associations of different blood pressure (BP) parameters and clinical outcome in ENCHANTED2/MT. Methods Post hoc analysis involving 816 ENCHANTED2/MT post-EVT patients randomly allocated to more-intensive (SBP target 120 mmHg) versus less-intensive (SBP target 140-180 mmHg) BP-lowering. BP parameters were mean achieved SBP between 1 h and 24 h post-randomisation and magnitude of reduction in 1 h. Functional outcome was death or major disability (mRS 3-6) at 90 days. Safety outcome was any severe adverse event (SAE). Logistic regression and restricted cubic splines were conducted, with adjustment for treatment group, NIHSS, age, sex, and degree of reperfusion. Results Of 816 AIS patients (mean age 67 years, 38% female), the association shape showed a significant increase in the odds of poor functional outcome and SAE with an increase in achieved SBP above 125 mmHg. A J-shaped association was observed for SBP reduction in 1 h post-EVT and functional outcome: 30 mmHg was optimal, as both larger and smaller reductions increased the risk of poor functional outcome and SAE. Conclusions Targeting a SBP level of 125 mmHg is likely to provide the maximum benefit for patients who are hypertensive after EVT for acute ischaemic stroke. However, reducing the SBP too quickly and by an amount greater than 30 mmHg were also associated with increased odds of poor functional outcome and an SAE. Conflict of interest Xinwen Ren: nothing to disclose
Ren et al. (2026) studied this question.