Lack of consensus among stroke experts on the optimal blood pressure target of acute ischemic stroke: evidence from a national survey.

Introduction: There remains a lack of consensus among physicians regarding the blood pressure management strategy for acute ischemic stroke patients, this study sought to determine current practice patterns and extension of consensus among stroke physicians after publications of several randomized controlled trials (RCTs).

Methods: An online survey of stroke clinicians registered to OCIN (Oriental Conference of Interventional Neurovascology) platform and ENCHANTED2/MT trial (Enhanced Control of Hypertension and Thrombectomy Stroke Study) collaborators was conducted to investigate the blood pressure management strategy after mechanical thrombectomy. The survey was sent out in March 2024, extracted within 1 month, and then analyzed comprehensively using descriptive statistics.

Results: 351 available responses were collected and analyzed. These participants mostly come from tertiary-level hospitals (90.6%) in 31 provinces in China. During mechanical thrombectomy (MT), the most popular blood pressure (BP) target was 140-160 mmHg (36.5%, 128/351) and 120-140 mmHg (26.8%, 94/351). For patients achieved successful reperfusion, those who achieved expanded treatment in cerebral infarction (eTICI) 3 were expected to maintain BP target of 120-140 mmHg (56.7%, 199/351) or <120 mmHg (27.1%, 95/351), while eTICI 2b were wished to 120-140 mmHg (45.3%, 159/351) or 140-160mmHg (38.5%, 135/351). For patients who achieved unsuccessful reperfusion, the most selected BP target was 140-160mmHg (40.7%, 143/351). In brief, Clinical doctors from China with different experiences have different views on the goals of BP management.

Conclusions: The survey highlights inter-institutional variability among stroke experts regarding the optimal BP target for acute ischemic stroke. While a majority of institutions have established standardized protocols for post-MT BP management, further prospective randomized trials are warranted to determine the optimal BP target.