Key result
Intensive systolic blood pressure lowering showed a trend towards benefit in diabetic patients (OR 2.81; 95% CI 0.88-8.88; p=0.08), but not in non-diabetic patients.
Why the study?
It remained unknown whether the response to intensive SBP lowering after successful endovascular therapy for acute ischaemic stroke is modified by patient or clinical factors.
Does intensive systolic blood pressure lowering reduce intraparenchymal hemorrhage in patients with acute ischaemic stroke after successful endovascular therapy?
Does intensive systolic blood pressure lowering reduce intraparenchymal hemorrhage in patients with acute ischaemic stroke after successful endovascular therapy?
Intensive SBP lowering after successful endovascular therapy for acute ischemic stroke may offer a trend toward benefit in diabetic patients, though this requires further validation.
Should not change post-EVT BP targets; hypothesis-generating for intensive lowering in diabetic patients.
BACKGROUND: The Safety and Efficacy of Intensive Blood Pressure Lowering after Successful Endovascular Therapy in Acute Ischaemic Stroke (BP TARGET) trial demonstrated no benefit from intensive systolic blood pressure (SBP) treatment after successful reperfusion with endovascular therapy. However, it remains unknown if the response to blood pressure treatment is modified by other factors. OBJECTIVE: To carry out a post hoc analysis of the BP TARGET trial data to determine if the response to blood pressure treatment is modified by factors such as age, history of hypertension, recanalization status, location of occlusion, diabetes, hyperglycemia, or pretreatment with intravenous thrombolysis. METHODS: This is a post hoc analysis of the BP TARGET trial. Patients were divided into groups based on age, diabetes, blood glucose, site of occlusion, history of hypertension, and pretreatment with intravenous thrombolysis. The primary outcome was any intraparenchymal hemorrhage. There was a trend towards benefit from intensive SBP treatment in diabetic patients (OR=2.81; 95% CI 0.88 to 8.88; p=0.08) but not in non-diabetic patients (OR=0.75; 95% 0.45 to 126; p 0.28). Age, location of occlusion, admission SBP, pretreatment with intravenous thrombolysis, and history of hypertension did not modify the effect of intensive SBP treatment on any of the outcomes. CONCLUSION: The effect of SBP lowering treatment was not modified by age, location of occlusion history of hypertension, intravenous thrombolysis, and admission SBP. Diabetes modified the effect of intensive SBP lowering treatment, and there was a trend towards benefit from intensive SBP treatment in diabetic patients. This finding is hypothesis generating and requires further validation.
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Anadani et al. (2022) studied Acute ischaemic stroke. Intensive systolic blood pressure lowering was evaluated on Any intraparenchymal hemorrhage. Intensive systolic blood pressure lowering showed a trend towards benefit in diabetic patients (OR 2.81; 95% CI 0.88-8.88; p=0.08), but not in non-diabetic patients.
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