PDF: BP-TARGET
(2022)Objective
Whether intensive SBP lowering after successful thrombectomy reduces the rate of ICH compared to standard SBP management.
Study Summary
• No difference in ICH rates at 24–36 hours between groups.
• Hypotension occurred more frequently in the intensive group but was not statistically significant.
• Early mortality was slightly higher in the intensive group, but not significantly different.
• Hypotension occurred more frequently in the intensive group but was not statistically significant.
• Early mortality was slightly higher in the intensive group, but not significantly different.
Intervention
Randomized patients with successful thrombectomy for anterior circulation LVO to intensive SBP control (100–129 mm Hg) vs. standard control (130–185 mm Hg), initiated within 1 hour and maintained for 24 hours using IV medications.
Study Design
Arms: Array
Outcome
• Radiographic intraparenchymal hemorrhage: 42% (intensive) vs. 43% (standard), adjusted OR 0.96 (95% CI 0.60–1.51), p=0.84
• Hypotension: 8% (intensive) vs. 3% (standard), not statistically significant
• 1-week mortality: 7% (intensive) vs. 4% (standard)
• Hypotension: 8% (intensive) vs. 3% (standard), not statistically significant
• 1-week mortality: 7% (intensive) vs. 4% (standard)
Bottom Line
Patients treated with RAS inhibitors before stroke had less severe strokes and lower rates of intracranial hemorrhage than those on non-RAS inhibitors.
Major Points
- Post hoc analysis of 203 hypertensive patients from BP TARGET trial.
- RAS inhibitors were associated with lower baseline NIHSS scores.
- Non-RAS inhibitors (CCB, diuretics) were linked to higher NIHSS and more intracranial hemorrhage.
- RAS inhibitors showed a trend toward better 24-hour NIHSS improvement.
- No significant differences in 3-month functional outcomes after multivariate adjustment.
Study Design
- Study Type
- Post hoc analysis of a randomized, controlled trial
- Randomization
- Yes
- Blinding
- Open-label with blinded outcome assessment
- Sample Size
- 203
- Follow-up
- 3 months
- Centers
- 4
- Countries
- France
Primary Outcome
Definition: Baseline NIHSS score
| Control | Intervention | HR/OR | P-value |
|---|---|---|---|
| 17.80 | 15.81 | - (-5.37 to -0.25) | 0.031 |
Limitations & Criticisms
- Post hoc observational analysis with potential confounding.
- Moderate sample size limited statistical power.
- AHT regimens often mixed, limiting direct comparisons.
- BP control history prior to stroke not available.
- Findings may not apply to AIS patients not treated with EVT.
Citation
Maïer B, et al. Stroke. 2022;53:1837–1846. DOI: 10.1161/STROKEAHA.121.037548