Intensive Versus Conventional Blood Pressure Lowering After Successful Endovascular Thrombectomy: OPTIMAL-BP 1-Year Outcomes

 

I think the real problem here is THAT NO ONE IS THINKING AT ALL! Why lower pressure since that would deliver less oxygen, thus hastening the death of neurons!

I think it's because that elevated pressure delivers more oxygen keeping your neurons functioning better.

And this one:

The One Benefit Of High Blood Pressure? It May Prevent Dementia August 2014

 

The latest here: 

Intensive Versus Conventional Blood Pressure Lowering After Successful Endovascular Thrombectomy: OPTIMAL-BP 1-Year Outcomes

Jae Wook Jung, MD, PhD https://orcid.org/0000-0002-9219-8522, Young Dae Kim, MD, PhD https://orcid.org/0000-0001-5750-2616, 

JoonNyung Heo, MD, PhD https://orcid.org/0000-0001-6287-6348, Hyungwoo Lee, MD, 

Byung Moon Kim, MD, PhD https://orcid.org/0000-0001-8593-6841, Dong Joon Kim, MD, PhD https://orcid.org/0000-0002-7035-087X, 

Na-Young Shin, MD, PhD https://orcid.org/0000-0003-1157-6366, … Show All … , and Hyo Suk Nam, MD, PhD https://orcid.org/0000-0002-4415-3995 hsnam@yuhs.acAuthor Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.126.055632

 

Abstract

BACKGROUND:

Intensive blood pressure (BP) lowering after successful reperfusion has resulted in short-term harm in acute ischemic stroke. However, it remains unclear whether these adverse effects persist over the long term.

METHODS:

The OPTIMAL-BP (Outcome in Patients Treated With Intra-Arterial Thrombectomy–Optimal Blood Pressure Control) was a phase 3, multicenter, prospective, open-label, blinded end point, randomized controlled trial with 19 centers throughout South Korea. Patients who underwent endovascular thrombectomy for acute ischemic stroke caused by large vessel occlusion, achieved successful reperfusion of the occluded artery, and exhibited elevated BP (systolic BP ≥140 mm Hg) on 2 measurements obtained 2 minutes apart within 2 hours after recanalization were randomly assigned to receive intensive BP management (systolic BP target <140 mm Hg) or conventional management (systolic BP target, 140–180 mm Hg) for 24 hours after enrollment. This study was a 1-year follow-up extension of the OPTIMAL-BP. The primary outcomes were a modified Rankin Scale score of 0 to 2 at 1 year, indicating functional independence and all-cause mortality within 1 year. Adjusted odds ratios were estimated using multivariable logistic regression models adjusting for age, sex, onset-to-randomization time, and baseline National Institutes of Health Stroke Scale.

RESULTS:

Among 306 randomized patients, 294 (96.1%) completed the 1-year follow-up. In the intention-to-treat analysis, functional independence at 1 year was numerically lower in the intensive BP management group than in the conventional group (40.5% versus 52.7%; adjusted odds ratios, 0.59 [95% CI, 0.34–1.00]; P=0.051). Consistent findings were observed in the per-protocol analysis (41.1% versus 54.7%; adjusted odds ratios, 0.56 [95% CI, 0.32–0.97]; P=0.040). One-year mortality and distribution of modified Rankin Scale changes from 3 months to 1 year did not differ between groups.

CONCLUSIONS:

Intensive BP lowering targeting a systolic BP of <140 mm Hg resulted in worse functional outcomes at 1 year compared with conventional BP management. These randomized data suggest that early postthrombectomy BP management has durable effects on recovery and support current recommendations against intensive BP lowering.

REGISTRATION:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT04205305.