Benjamin Maïer1,2,3,4, Benjamin Gory5,6, Bertrand Lapergue7, Igor Sibon8, Simon Escalard1, Maeva Kyheng9, Julien Labreuche9, Adam de Havenon10, Nils Petersen11, Mohammad Anadani12, Etienne Gayat2,13,14, Perrine Boursin1, Malek Ben Maacha1, Jean-Philippe Desilles1,2,3,15, Raphael Blanc1,3,15, Michel Piotin1,3,15, Jean-Michel Halimi4,16,17, Mikael Mazighi1,2,3,15. 1. Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France. 2. University of Paris, Paris, France. 3. FHU NeuroVasc, Paris, France. 4. EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France. 5. Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, University of Lorraine, Nancy, France. 6. IADI, INSERM U1254, University of Lorraine, Nancy, France. 7. Division of Neurology, Department of Neurology, Stroke Center, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France. 8. Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France. 9. University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France. 10. Neurology Department, University of Utah, Salt Lake City, Utah, USA. 11. Neurocritical Care and Emergency Neurology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA. 12. Washington University School of Medicine in St Louis, St Louis, Missouri, USA. 13. Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, Paris, France. 14. INSERM UMR-S 942, Cardiovascular Makers in Stress Conditions, Paris, France. 15. Laboratory of Vascular Translational Science, INSERM U1148, Paris, France. 16. Nephrology Department, Tours Hospital, Tours, France. 17. University of Tours, Tours, France.
Abstract
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.
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.