Lower SBP Targets After Endovascular Therapy Do Not Meet Futility Criteria

Sep 21, 2023

WEDNESDAY, Sept. 20, 2023 (HealthDay News) — For patients with acute ischemic stroke undergoing endovascular therapy, lower systolic blood pressure (SBP) targets do not meet prespecified criteria for futility, according to a study published in the Sept. 5 issue of the Journal of the American Medical Association.

Eva A. Mistry, M.B.B.S., from the University of Cincinnati, and colleagues examined the futility of lower SBP targets versus a higher target (<140 or <160 mm Hg versus ≤180 mm Hg) after endovascular therapy in a randomized, phase 2 trial involving 120 patients with acute ischemic stroke who had undergone successful endovascular therapy during January 2020 to March 2022.

The researchers found that the mean follow-up infarct volume was 32.4, 50.7, and 46.4 mL for the <140, <160, and ≤180 mm Hg groups, respectively. The mean utility-weight modified Rankin Scale (mRS) score was 0.51, 0.47, and 0.58 for the <140, <160, and ≤180 mm Hg groups, respectively. For each mm Hg decrease in the SBP target, the slope of follow-up infarct volume was −0.29 and the slope of the utility-weighted mRS score was −0.0019. The predicted probability of success for a future trial was 25 and 14 percent for the <140 and <160 mm Hg groups, respectively, compared with the ≤180 mm Hg group.

“Although the study did not find significant evidence of an unequivocal harm of lower blood pressure targets in this population in terms of worsening size of stroke or increasing disability, the trends indicated that there may only be marginal benefit of lowering postendovascular treatment blood pressure on patients’ long-term disability,” Mistry said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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