Abstract WP345: Blood Pressure Control Post-Endovascular Stroke Treatment: Evidence from an Updated Meta-Analysis of Functional and Safety Outcomes

Background: Previous meta-analyses evaluating blood pressure (BP) management following endovascular stroke treatment (EVT) demonstrated a non-significant effect on all-cause mortality (OR 1.30; 95% CI 0.98–1.71). The recently published IDENTITY trial, a randomized controlled study, provides new data that may influence these findings. Methods: We conducted a systematic review and meta-analysis of all six published randomized controlled trials (RCTs) (n = 1,945 patients) comparing: Intensive BP control: target systolic BP <130 mmHg Conventional BP control: target systolic BP 140–180 mmHg Primary outcomes were 90-day all-cause mortality and functional independence (modified Rankin Scale mRS 0–2). Secondary outcomes included unfavorable recovery (mRS 3–6), symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and malignant edema. Pooled odds ratios (ORs) were calculated using a random-effects model. Results: Mortality: In prior analyses, mortality differences were non-significant (OR 1.30, 95% CI 0.98–1.71). Incorporating IDENTITY trial data rendered the mortality difference statistically significant, with 26% higher mortality in the conventional BP group (OR 1.26, 95% CI 1.00–1.60; p = 0.05, corresponding to a 21% mortality reduction with intensive BP control (1/1.26 = 0.79). Functional Outcomes: Intensive BP control was associated with 32% lower odds of good functional outcome (mRS 0–2) (OR 0.68, 95% CI 0.57–0.82; p < 0.001) and 47% higher odds of unfavorable recovery (mRS 3–6) (OR 1.47, 95% CI 1.23–1.77). Safety Outcomes: No significant differences were found in sICH (OR 1.18, 95% CI 0.84–1.65) or any ICH (OR 1.10, 95% CI 0.91–1.32). A non-significant trend toward higher malignant edema was observed with intensive BP control (OR 1.86, 95% CI 0.94–3.68). Conclusion: This updated meta-analysis of six RCTs, including the IDENTITY trial, indicates that intensive BP management after EVT significantly reduces all-cause mortality but is associated with worse functional outcomes. Safety outcomes remain largely unchanged. These findings underscore the complexity of post-EVT BP management and the need for further trials to determine optimal treatment strategies.