Deans' stroke musings: Intensive BP lowering did not improve functional outcomes after EVT for stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, March 30, 2025

Intensive BP lowering did not improve functional outcomes after EVT for stroke

Because our incompetent stroke medical 'professionals' still haven't figured out an EXACT BLOOD PRESSURE MANAGEMENT PROTOCOL post stroke! And YOU bear the failure of that! Hope your competent? doctor guesses correctly because the poor outcome happens to you! Your doctor gets off scot-free and still gets paid! My non-medical thinking on this is that by doing this you are vastly lowering the oxygen supply to the brain thus hastening the neuronal cascade of death!

blood pressure management (90 posts to June 2017)

Intensive BP lowering did not improve functional outcomes after EVT for stroke

ByScott Buzby

Fact checked byRichard Smith

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.

blood pressure monitor — Intensive BP lowering after endovascular thrombectomy for stroke did not improve functional outcomes. *Image: Adobe Stock*

“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.”

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