Xia Wang
Associations of Early Systolic Blood Pressure Control and Outcome after Thrombolysis-Eligible Acute Ischemic Stroke: Results from the ENCHANTED Study
Wang, Xia; Minhas, Jatinder S; Moullaali, Tom J.; Luca Di Tanna, Gian; Lindley, Richard I; Chen, Xiaoying; Arima, Hisatomi; Chen, Guofang; Delcourt, Candice; Bath, Philip M; Broderick, Joseph P; Demchuk, Andrew M.; Donnan, Geoffrey A.; Durham, Alice C.; Lavados, Pablo M.; Lee, Tsong Hai; Levi, Christopher; Martins, Sheila O.; Olavarria, Veronica V.; Pandian, Jeyaraj D.; Parsons, Mark W.; Pontes-Neto, Octavio M.; Ricci, Stefano; Sato, Shoichiro; Sharma, Vijay K.; Silva, Federico; Thang, Nguyen H.; Wang, Ji Guang; Woodward, Mark; Chalmers, John; Song, Lili; Anderson, Craig S.; Robinson, Thompson G.
Authors
Jatinder S Minhas
Tom J. Moullaali
Gian Luca Di Tanna
Richard I Lindley
Xiaoying Chen
Hisatomi Arima
Guofang Chen
Candice Delcourt
PHILIP BATH philip.bath@nottingham.ac.uk
Stroke Association Professor of Stroke Medicine
Joseph P Broderick
Andrew M. Demchuk
Geoffrey A. Donnan
Alice C. Durham
Pablo M. Lavados
Tsong Hai Lee
Christopher Levi
Sheila O. Martins
Veronica V. Olavarria
Jeyaraj D. Pandian
Mark W. Parsons
Octavio M. Pontes-Neto
Stefano Ricci
Shoichiro Sato
Vijay K. Sharma
Federico Silva
Nguyen H. Thang
Ji Guang Wang
Mark Woodward
John Chalmers
Lili Song
Craig S. Anderson
Thompson G. Robinson
Abstract
Background and Purpose: In thrombolysis-eligible patients with acute ischemic stroke, there is uncertainty over the most appropriate systolic blood pressure (SBP) lowering profile that provides an optimal balance of potential benefit (functional recovery) and harm (intracranial hemorrhage). We aimed to determine relationships of SBP parameters and outcomes in thrombolyzed acute ischemic stroke patients. Methods: Post hoc analyzes of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial-factorial trial of thrombolysis-eligible and treated acute ischemic stroke patients with high SBP (150-180 mm Hg) assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) alteplase and intensive (target SBP, 130-140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) treatment. All patients were followed up for functional status and serious adverse events to 90 days. Logistic regression models were used to analyze 3 SBP summary measures postrandomization: attained (mean), variability (SD) in 1-24 hours, and magnitude of reduction in 1 hour. The primary outcome was a favorable shift on the modified Rankin Scale. The key safety outcome was any intracranial hemorrhage. Results: Among 4511 included participants (mean age 67 years, 38% female, 65% Asian) lower attained SBP and smaller SBP variability were associated with favorable shift on the modified Rankin Scale (per 10 mm Hg increase: odds ratio, 0.76 [95% CI, 0.71-0.82]; P<0.001 and 0.86 [95% CI, 0.76-0.98]; P=0.025) respectively, but not for magnitude of SBP reduction (0.98, [0.93-1.04]; P=0.564). Odds of intracranial hemorrhage was associated with higher attained SBP and greater SBP variability (1.18 [1.06-1.31]; P=0.002 and 1.34 [1.11-1.62]; P=0.002) but not with magnitude of SBP reduction (1.05 [0.98-1.14]; P=0.184). Conclusions: Attaining early and consistent low levels in SBP <140 mm Hg, even as low as 110 to 120 mm Hg, over 24 hours is associated with better outcomes in thrombolyzed acute ischemic stroke patients. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01422616.
Citation
Wang, X., Minhas, J. S., Moullaali, T. J., Luca Di Tanna, G., Lindley, R. I., Chen, X., …Robinson, T. G. (2022). Associations of Early Systolic Blood Pressure Control and Outcome after Thrombolysis-Eligible Acute Ischemic Stroke: Results from the ENCHANTED Study. Stroke, 53(3), 779-787. https://doi.org/10.1161/strokeaha.121.034580
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 21, 2021 |
Online Publication Date | Oct 27, 2021 |
Publication Date | Mar 1, 2022 |
Deposit Date | Jun 25, 2021 |
Publicly Available Date | Apr 28, 2022 |
Journal | Stroke |
Print ISSN | 0039-2499 |
Electronic ISSN | 1524-4628 |
Publisher | American Heart Association |
Peer Reviewed | Peer Reviewed |
Volume | 53 |
Issue | 3 |
Pages | 779-787 |
DOI | https://doi.org/10.1161/strokeaha.121.034580 |
Keywords | Ischemic stroke; intracranial hemorrhage; blood pressure; hypertension |
Public URL | https://nottingham-repository.worktribe.com/output/5722765 |
Publisher URL | https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.034580 |
Files
Associations Of Early Systolic Blood Pressure Control
(1.4 Mb)
PDF
You might also like
Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke
(2016)
Journal Article
Stroke outcome in clinical trial patients deriving from different countries
(2008)
Journal Article
Downloadable Citations
About Repository@Nottingham
Administrator e-mail: discovery-access-systems@nottingham.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search