Intensive BP lowering did not improve functional outcomes after EVT for stroke
Key takeaways:
- Intensive BP lowering after endovascular thrombectomy for stroke did not improve functional outcomes.
- The trial was halted early due to possible harm from the intervention.
Intensive BP lowering after successful endovascular thrombectomy for acute anterior circulation ischemic stroke did not improve 90-day functional outcomes vs. standard BP control, a speaker reported.
The results of the IDENTIFY trial, which was halted early due to safety concerns, were presented at the International Stroke Conference.
“Endovascular thrombectomy (EVT) has become the standard treatment for acute ischemic stroke due to large vessel occlusion. However, although recanalization can be achieved in more than 80% of patients who had received EVT, more than half of these patients remained functional dependence after treatment,” Bo Wu, MD, professor of neurology at West China Hospital of Sichuan University, in Chengdu, China, said during a presentation. “According to some previous evidence, we hypothesize that the effect of blood pressure on functional outcomes might be affected by time. For example, subgroup analyses of the ENCHANTED2/MT indicated significant adverse effect of intensive BP management in patients who achieved recanalization beyond 6 hours after onset, but not in those within 6 hours.”
For the present trial, Wu and colleagues investigated the impact of intensive BP lowering among 600 Chinese patients with acute ischemic stroke who underwent successful EVT within 6 hours of symptom onset. Participants were randomly assigned to intensive BP lowering with a target lower than 130 mm Hg or standard care with a target lower than 180 mm Hg for 24 hours after EVT.
The primary outcome was unfavorable functional outcomes at 90 days, defined as a modified Rankin score of 3 to 6.
Xuening Zhang, PhD, research assistant in the department of neurology at West China Hospital of Sichuan University, reported that the trial was terminated early, per recommendations from an independent data monitoring committee, after completing the first 90 days of follow-up for the first 383 patients. Termination was due to neutral results and possible harmful effects.
The mean age of the cohort was 72 years and nearly half were women.
Approximately 60% of participants had cardioembolic stroke and thrombolysis was performed in approximately 42% of patients. More than half underwent EVT under general anesthesia, according to the presentation.
Although significantly lower BP was achieved in the intensive BP lowering group, risk for the primary outcome was not significantly different compared with the standard BP lowering group (RR = 1.05; 95% CI, 0.92-1.2; P = .45).
In adjusted analyses, the researchers observed increased risk for both severe disability, defined as modified Rankin score of 4 to 5 (RR = 1.45; 95% CI, 1.1-1.9; P = .009), and death and severe disability (RR = 1.25; 95% CI, 1.07-1.45; P = .005) among participants assigned to intensive BP lowering compared with standard BP lowering.
“Existing randomized trials have explored several potential systolic BP targets after EVT. No sufficient evidence supports intensive BP management after successful EVT, regardless of the duration of the ischemic period,” Zhang said during the presentation. “Additionally, there is a high rate of cardioembolism in our trial, suggesting that blood pressure reduction to below 130 mm Hg did not benefit these patients.”
Collapse
Zhang X, et al. LB17. Presented at: International Stroke Conference; Feb. 5-7, 2025; Los Angeles (hybrid meeting).