Challenging current practice, an intensive systolic blood pressure-lowering strategy did not reduce radiographic intraparenchymal hemorrhage rates after successful endovascular strategy for acute ischemic stroke, according to study results published in The Lancet Neurology.
BP TARGET is the first randomized controlled trial to assess the efficacy of this strategy on radiographic intraparenchymal hemorrhage rates, the most serious complication following cerebral reperfusion.
Study researchers conducted the multicenter trial at 4 hospital centers in France. Adult patients with acute ischemic stroke after large-vessel occlusion successfully treated with endovascular therapy were randomly assigned to either an intensive (100-129 mm Hg) or standard care systolic blood pressure target group (130-185 mm Hg). Blood pressure was noninvasively measured every 15 minutes for the first 2 hours, then every 30 minutes for 6 hours, and then hourly for 16 hours.
Reperfusion occurred within a median of 285 minutes in the intensive target group and 297 minutes in the standard target group after symptom onset. At reperfusion, among the 236 included patients, mean systolic blood pressure was 155 mm Hg (standard deviation [SD], 26) in the intensive target group and 152 mm Hg (SD, 25) in the standard target group.
In the 24-hour period after reperfusion, the median number of systolic blood pressure measurements was 33 with mean systolic blood pressure of 128 mm Hg (SD, 11) in the intensive target group and 138 mm Hg (SD, 17) in the standard systolic blood pressure target group. Most patients who received the majority of their planned systolic blood pressure measurements spent more than half their time in their assigned target range of systolic blood pressure (intensive target group: 61%; standard target group: 66.6%).
Radiographic intraparenchymal hemorrhage on computed tomography (CT) at 24 to 36 hours occurred in 65 of 154 patients in the intensive systolic blood pressure target group and 68 of 157 in the standard systolic blood pressure target group (adjusted odds ratio [aOR], 0.96; 95% CI, 0.60 to 1.51; P =.84;corresponding risk difference: -1.1%; 95% CI, -11.6 to 10.1).
Symptomatic intraparenchymal hemorrhage and parenchymal hemorrhage type 2 were slightly more common among the intensive target group (17, 15, respectively) than among the standard target group (11, 12, respectively).
Hypotensive events occurred in 12 patients in the intensive target group and 5 in the standard target group. One patient in the intensive target group had a hemicraniectomy.
All-cause mortality occurred in 32 in the intensive target group and 24 in the standard target group. In the first week after randomization, 11 patients in the intensive target group and 7 patients in the standard target group died.
Limitations of the study included obstacles to controlling systolic blood pressure, a difference in primary outcome rates between centers, the time to reach the systolic blood pressure target exceeding the protocol’s target of 1 hour, and most individuals being treated under conscious sedation.
Study researchers concluded that their findings bring no evidence of any effect of an intensive strategy to lower hemorrhage rates after acute ischemic stroke compared with a standard care systolic blood pressure target. They added, “Further studies are needed to understand the association between blood pressure and outcomes after reperfusion.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Mazighi M, Richard S, Lapergue B, et al. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET): a multicentre, open-label, randomised controlled trial. The Lancet Neurology. Published online February 26, 2021. doi:10.1016/S1474-4422(20)30483-X