Wern Yew Ding, MBChB

van den Berg SA, Uniken Venema SM, Mulder MJHL, Treurniet KM, Samuels N, Lingsma HF, Goldhoorn R-JB, Jansen IGH, Coutinho JM, Roozenbeek B, et al. Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment. Stroke. 2020;51:3205–3214.

Endovascular treatment for early recanalization of an occluded artery has broadly been recognized to be an important aspect in the management of acute ischemic stroke. Yet, despite improvements in functional outcomes offered by this strategy, a significant proportion of patients have severe disability at follow-up. Therefore, additional targets for treatment need to be identified.

In a recent post-hoc analysis of the MR CLEAN Registry, Berg and colleagues assessed the relationship between admission blood pressure and short-term outcomes of ischemic stroke in patients treated with endovascular treatment. In brief, the MR CLEAN Registry was a prospective, observational cohort study of consecutive patients with ischemic stroke who were treated with endovascular treatment in the Netherlands. For the purposes of this analysis, the authors focused on adult patients who had a groin puncture within 6.5 hours after stroke onset and had intracranial proximal arterial occlusion in the anterior circulation, as demonstrated by computed tomography angiography.

At baseline, there was a total of 3,092 patients with a median age of 72 years. Patients were divided into 2 groups, depending on their admission systolic blood pressure (≥150 vs. <150 mmHg). As expected, those in the former group were older and had a higher prevalence of known hypertension and diabetes mellitus. The mean systolic blood pressure between the groups were 169 and 130 mmHg.

Among patients with a systolic blood pressure equal or above 150 mmHg at admission, higher blood pressure values were associated with increased odds of poor functional outcome and mortality at 90 days. There was also a reduced probability of successful reperfusion and a tendency towards symptomatic intracranial hemorrhage. These findings were not observed in those with an admission blood pressure below 150 mmHg.

A limitation of the study was the fact that the admission blood pressure was used instead of pre-endovascular treatment recordings. In this regard, patients with a high blood pressure at admission may have received treatment with blood pressure lowering effects. Furthermore, determining the target blood pressure that is associated with better outcomes is more important than the blood pressure at presentation, which physicians have little control over.

Overall, the findings from this study suggest that blood pressure has an important influence in the outcomes of patients with acute ischemic stroke who are treated with endovascular treatment. Further studies are needed to investigate the impact of blood pressure modification in such situations.