Article Commentary: “Magnitude of Blood Pressure Change After Endovascular Therapy and Outcomes: Insight From the BP-TARGET Trial”
Sishir Mannava, MD
Anadani M, Maïer B, Escalard S, Labreuche J, de Havenon A, Sabben C, Lapergue B, Gory B, Richard S, Sibon I, et al. Magnitude of Blood Pressure Change After Endovascular Therapy and Outcomes: Insight From the BP-TARGET Trial. Stroke. 2022.
Blood pressure (BP) control after endovascular therapy (EVT) for large vessel occlusion is an oft-debated topic. Many stroke providers, although aware of the potential harm of reperfusion injury, do not know how aggressive to be with BP lowering. The risk with acute lowering of BP is also the risk of hypoperfusion and placing the penumbra at risk of worsening ischemic damage. The authors of this work conducted a post-hoc analysis of the BP TARGET trial (recently published and showing neutral results from intensive BP lowering in patients with successful reperfusion after EVT) to assess the association between change in systolic blood pressure at different time intervals with clinical and radiographic outcomes.
This was a secondary observational post-hoc analysis of the original BP TARGET trial, which enrolled patients with anterior circulation large vessel occlusion stroke and had acute ischemic stroke with successful reperfusion with EVT but had SBP > 130 mmHg at end of procedure (considered the baseline SBP). Patients in the BP TARGET trial were randomized 1:1 to intensive SBP treatment to be achieved within 1 hour of randomization (target 100-129 mmHg) or standard SBP treatment (130-185mmHg). BP was measured every 15 minutes for 2 hours after randomization, then every 30 minutes for 6 hours and then every hour for the remaining 16 hours. The authors defined ΔSBP as baseline SBP minus the mean of achieved SBP levels during 3 periods post-reperfusion: 15 to 60 minutes (ΔSBP15–60M), 1 to 6 hours (ΔSBP1–6H), and 6 to 24 hours (ΔSBP6–24H).