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Anadani M, Maier B, Escalard S, Labreuche J, de Havenon A, Sabben C, Lapergue B, Mistry EA, Gory B, Spiotta AM, Richard S, Sibon I, Desilles JP, Blanc R, Piotin M, Mazighi M. Safety and efficacy of intensive systolic blood pressure lowering after successful endovascular therapy: a post hoc analysis of the BP TARGET trial. J Neurointerv Surg 2023; 15:e142-e147. [PMID: 36220337 DOI: 10.1136/jnis-2022-019130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/28/2022] [Indexed: 11/03/2022]
Abstract
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. RESULTS 318 patients were included. Diabetes modified the treatment effect on favorable functional outcome (Pheteogenity=0.041). 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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Affiliation(s)
- Mohammad Anadani
- Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin Maier
- Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
| | - Simon Escalard
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | | | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Candice Sabben
- Department of Neurology, Fondation Rothschild Hospital, paris, France
| | | | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sébastien Richard
- Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
| | | | | | - Raphael Blanc
- Department of Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
| | - Michel Piotin
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Mikaël Mazighi
- Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
- Department of Neurology, GH Lariboisiere Fernand-Widal, Paris, France
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Ishitsuka K, Kamouchi M, Hata J, Fukuda K, Matsuo R, Kuroda J, Ago T, Kuwashiro T, Sugimori H, Nakane H, Kitazono T. High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes. Hypertension 2014; 63:54-60. [DOI: 10.1161/hypertensionaha.113.02189] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between the poststroke blood pressure (BP) and functional outcomes in patients with acute ischemic stroke is still controversial. The aim of the present study was to elucidate the impact of the poststroke BP on the clinical outcomes of acute ischemic stroke. Among the patients in the Fukuoka Stroke Registry, 1874 patients with first-ever acute ischemic stroke (within 24 hours of onset) who had been functionally independent before onset were prospectively enrolled in the present study. The poststroke BP levels were defined as the average values during the 48 hours after onset. The study outcomes were a good neurological recovery, neurological deterioration, and a poor functional outcome. The higher poststroke BP levels were significantly associated with a lower probability of a good neurological recovery and elevated risks of neurological deterioration and a poor functional outcome after adjusting for potential confounding factors. The multivariate-adjusted odds ratios (95% confidence interval) in the highest quintile of systolic BP (versus the lowest quintile as a reference) were 0.51 (0.37–0.71) for a good neurological recovery, 1.92 (1.15–3.27) for neurological deterioration, and 2.51 (1.69–3.74) for a poor functional outcome. Similar associations were observed when we applied the poststroke diastolic BP or pulse pressure. No evidence of the J-curve phenomenon was observed for each association. These results suggest that a high poststroke BP was significantly associated with unfavorable clinical outcomes in patients with acute ischemic stroke. There was no evidence of the J-curve phenomenon between the poststroke BP levels and the clinical outcomes.
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Affiliation(s)
- Koji Ishitsuka
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Masahiro Kamouchi
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Jun Hata
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Kenji Fukuda
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Ryu Matsuo
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Junya Kuroda
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Tetsuro Ago
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Takahiro Kuwashiro
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Hiroshi Sugimori
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Hiroshi Nakane
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
| | - Takanari Kitazono
- From the Departments of Medicine and Clinical Science (K.I., R.M., J.K., T.A., T.K., H.S., T.K.), Health Care Administration and Management (M.K.), and Environmental Medicine (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Nephrology, Hypertension, and Strokology (K.I., M.K., J.H., J.K., T.A., T.K.), Emergency and Critical Care Center (T.K., H.S.), Kyushu University Hospital, Fukuoka, Japan; Division of Cardio-Vascular Medicine, Department of Internal
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