The impact of blood pressure management strategies on outcome in acute ischemic stroke patients after successful mechanical thrombectomy

A normal person would think that if your doctor doesn't EXACTLY KNOW WHAT TO DO: They would contact researchers to find the answer.  Hell this problem has been known for years and we still don't know what needs to be done. Hope you trust your doctor shooting in the dark. 

Are we ever going to get a blood pressure protocol? Or will we wait until stroke survivors are in charge? This question has been out there forever. Is your doctor and stroke hospital sitting on their asses WAITING FOR SOMEONE ELSE TO SOLVE THE PROBLEM? 

Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients July 2015

 

BP Lowering in Acute Stroke Flops for Improving Outcomes February 2015

 

After stroke, compared with Systolic Blood Pressure in the high range, low to normal SBP is associated with poorer mortality outcomes. May 2015

 

Systolic Blood Pressure and Mortality After Stroke May 2015

 

Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months June 2015

Blood pressure reduction in acute ischemic stroke according to time to treatment: a subgroup analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial May 2017

Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: Clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials February 2017 

But this to think about:

Don't go too low with blood pressure in hypertensive CAD patients

 

The latest here:

The impact of blood pressure management strategies on outcome in acute ischemic stroke patients after successful mechanical thrombectomy

Author links open overlay panelMichael J.GigliottiDO, MS¹VarunPadmanabanMD¹AliciaRichardsonMSN, RN²Scott D.SimonMD¹Ephraim W.ChurchMD¹

Kevin M.CockroftMD, MSc¹²

https://doi.org/10.1016/j.wneu.2021.01.052Get rights and content

Abstract

BACKGROUND

There is variability and no general consensus in how blood pressure should be managed after successful mechanical thrombectomy (MT) for large vessel ischemic stroke. We examined whether exceeding systolic blood pressure (SBP) targets in patients during the first 24 hours after successful MT led to worse outcomes.

METHODS

We retrospectively studied a consecutive sample of adult patients who underwent MT. We collected SBP data from the first 24 hours after MT and categorized them into 3 groups based on instances of SBP exceeding 140 mmHg, 160 mmHg, or 180 mmHg. Primary and secondary outcomes were patient’s modified Rankin Scale (mRS) status at discharge and 90-day follow-up and incidence of symptomatic intracranial hemorrhage (sICH), malignant cerebral edema, hemicraniectomy, mortality within 90 days, and discharge disposition.

RESULTS

A total of 117 patients were included (mean age 66 ± 13 years; 53% female). Patients with at least one instance of SBP ≥ 180 mmHg were found to be significantly associated with poor functional outcomes at discharge (adjusted OR 5.83; 95%CI, 1.41-32.9; P = 0.025), but not at 90-day follow-up. Patient’s with instances of SBP > 160 mmHg had independently increased odds of developing malignant cerebral edema (adjusted OR 17.07; 95%CI, 2.56 – 174.4; P = 0.01) and showed a trend towards increased odds of sICH (adjusted OR 4.42; 95%CI, 1.03 – 21.2; P = 0.0503).

CONCLUSIONS

Results suggest that individual instances of SBP elevation alone after successful MT, rather than necessarily prolonged increased blood pressure as reflected in mean or median BP values, may significantly impact clinical outcomes after successful MT.