[en] [en] BACKGROUND AND PURPOSE: The Blood Pressure Target in Acute Ischemic Stroke to Reduce Hemorrhage After Endovascular Therapy (BP TARGET) trial evaluated whether an intensive systolic blood pressure (SBP) target resulted in reduced rates of intracranial hemorrhage (ICH) after successful endovascular therapy (EVT) but did not assess the effect of blood pressure variability (BPV) on functional outcomes and ICH occurrence. We sought to evaluate this question in the BP TARGET trial.
METHODS: We performed a post hoc analysis of the BP TARGET trial and included patients with at least 50% of blood pressure (BP) recordings during the first 24 h after EVT. BPV parameters were SBP and diastolic BP (DBP) coefficient of variation (CV), standard deviation (SD), maximum-minimum (max-min), successive variation (SV), and time rate. The primary outcome was favorable functional outcome (3-month modified Rankin Scale between 0 and 2); the secondary outcome was the rate of ICH at 24 h.
RESULTS: We included 290 patients (mean number of BP measures = 30.4, SD = 8.0). BPV parameters (SBPSD , SBPmax-min , SBPCV ) were higher in the intensive SBP target group. Only DBP BPV parameters were associated with worse functional outcomes in the unadjusted model (DBPSD , DBPmax-min , DBPCV , and DBPSV ), but not after adjustment. Higher SBPmax-min was associated with worse functional outcomes in Thrombolysis in Cerebral Infarction 2B patients (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.38-1.02), but not in patients with complete reperfusion (OR = 1.27, 95% CI = 0.80-2.02, p for heterogeneity (phet =0.037). None of the BPV parameters was associated with ICH, regardless of the randomization group or the reperfusion grade.
CONCLUSIONS: BPV was significantly higher in the intensive SBP target group but was not associated with functional outcome or ICH.
Disciplines :
Neurology
Author, co-author :
Maïer, Benjamin ; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France ; University of Paris, Paris, France ; FHU NeuroVasc, Paris, France ; EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France
Gory, Benjamin; Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, University of Lorraine, Nancy, France ; IADI, INSERM U1254, University of Lorraine, Nancy, France
Lapergue, Bertrand; Division of Neurology, Department of Neurology, Stroke Center, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
Sibon, Igor ; Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France
Escalard, Simon ; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
Kyheng, Maeva; University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
Labreuche, Julien; University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France
de Havenon, Adam; Neurology Department, University of Utah, Salt Lake City, Utah, USA
Petersen, Nils; Neurocritical Care and Emergency Neurology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA
Anadani, Mohammad; Washington University School of Medicine in St Louis, St Louis, Missouri, USA
Gayat, Etienne; University of Paris, Paris, France ; Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, Paris, France ; INSERM UMR-S 942, Cardiovascular Makers in Stress Conditions, Paris, France
Boursin, Perrine; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
Ben Maacha, Malek; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France
Desilles, Jean-Philippe; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France ; University of Paris, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Blanc, Raphael; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Piotin, Michel; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Halimi, Jean-Michel; EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France ; Nephrology Department, Tours Hospital, Tours, France ; University of Tours, Tours, France
Mazighi, Mikael; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France ; University of Paris, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
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