Blood pressure threshold and outcomes after successful endovascular thrombectomy.

IF 8.7 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2025-08-01 DOI:10.1177/17474930251366063

Jae Wook Jung, Hyungwoo Lee, JoonNyung Heo, Young Dae Kim, Byung Moon Kim, Dong Joon Kim, Na-Young Shin, Haram Joo, Seong Hwan Ahn, Hyungjong Park, Sung-Il Sohn, Jeong-Ho Hong, Jaeseob Yun, Tae-Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon-Duk Seo, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Dong Hoon Shin, Jinkwon Kim, Joonsang Yoo, Minyoul Baik, Yo Han Jung, Yang-Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Il Hyung Lee, Jin Kyo Choi, Soyoung Jeon, Hye Sun Lee, Kwang Hyun Kim, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam

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引用次数: 0

Abstract

Background: Several randomized clinical trials have indicated that intensive blood pressure (BP) lowering is associated with worse outcomes, leaving the optimal BP targets following endovascular thrombectomy (EVT) uncertain.

Aims: This study aimed to investigate the relationship between specific systolic BP (SBP) thresholds, time spent outside these thresholds, and clinical outcomes.

Methods: This post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP) trial, included patients with successful EVT randomized to intensive (<140 mmHg) or conventional (140-180 mmHg) BP management. We analyzed SBP parameters, including mean, maximum, and minimum SBP during study period, as well as excursions beyond predefined SBP thresholds (<90, <100, <110, >170, >180, and >190 mmHg), and the cumulative and continuous durations of these excursions. Associations with 3 month modified Rankin Scale (mRS) and symptomatic intracerebral hemorrhage (sICH) were assessed using multivariable logistic and ordinal regression models.

Results: A total of 302 patients (median 75 years; 180 [59.6%] men) were analyzed with 11,461 BP measurements recorded during the first 24 hours after EVT. Prolonged hypoperfusion (SBP below 100 mmHg for continuous duration) was associated with worse mRS score (adjusted OR [aOR] 1.21 per hour, 95% CI [1.02-1.45]; P = 0.030) and increased sICH risk (aOR 1.49 per hour, 95% CI [1.15-1.97]; P = 0.004). SBP surges above 190 mmHg were linked to mRS worsening (aOR 2.60, 95% CI [1.05-6.53]; P = 0.039), but upper threshold-related parameters were not significantly associated with sICH.

Conclusion: Prolonged hypoperfusion below 100 mmHg and extreme surges above 190 mmHg, rather than specific SBP parameters, were associated with poor functional outcomes. These findings highlight the need for a threshold-based BP management approach post-EVT to minimize prolonged hypotension and excessive surges.

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血管内取栓成功后的血压阈值和预后。

背景：几项随机临床试验表明，强化降压（BP）与较差的预后相关，这使得血管内血栓切除术（EVT）后的最佳血压目标不确定。目的：本研究旨在探讨特定收缩压（SBP）阈值、超出这些阈值的时间和临床结果之间的关系。方法：对动脉内取栓治疗患者的结果进行事后分析-最佳血压控制（OPTIMAL-BP）试验，包括EVT成功的患者，随机分为强化（170、180和190 mmHg），以及这些短途活动的累积和持续时间。采用多变量logistic和有序回归模型评估3个月改良兰金量表（mRS）与症状性脑出血（sICH）的相关性。结果：共302例患者(中位年龄75岁；对180例（59.6%）男性患者进行分析，在EVT后的前24小时内记录了11461次血压测量。长期低灌注（收缩压持续低于100 mmHg）与较差的mRS评分相关(调整OR [aOR] 1.21 /小时，95% CI [1.02-1.45]；P=0.030)，脑出血风险增加(aOR为1.49 / h, 95% CI [1.15-1.97]；P = 0.004)。收缩压高于190 mmHg与mRS恶化相关(aOR 2.60, 95% CI [1.05-6.53]；P=0.039)，但上阈值相关参数与siich无显著相关性。结论：长期低于100 mmHg的低灌注和高于190 mmHg的极端激增，而不是特定的收缩压参数，与不良的功能结局相关。这些发现强调了evt后基于阈值的血压管理方法的必要性，以尽量减少长期低血压和过度的血压升高。试验注册：ClinicalTrials.gov标识符：NCT04205305。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.