“Intensive blood pressure control to a systolic target of less than 120 mm Hg to be harmful,” warn the authors of the new study.
The trial’s findings were announced in a late-breaking session at the World Stroke Congress and simultaneously published in The Lancet. The experiment was halted early due to the significance of the findings.
Professor Craig Anderson, Director of Global Brain Health at The George Institute for Global Health, stated that the fast onset of this effect indicated that the more forceful method was impeding the return of blood flow to the damaged region.
He said, “Our study provides a strong indication that this increasingly common treatment strategy should now be avoided in clinical practice.”
Approximately 85% of strokes are ischemic strokes, which result in the loss of neurological function by preventing blood flow to a portion of the brain due to a blood artery blockage.
Endovascular thrombectomy, a non-surgical procedure that is becoming more and more popular for treating ischemic stroke, involves inserting tiny tubes known as microcatheters into the blood clot and dissolving it.
The quick restoration of blood flow to an area that has been devoid of oxygen for some time may result in tissue damage known as reperfusion injury, which is a possible disadvantage of this already commonly practiced and successful treatment, according to Professor Anderson.
“This has resulted in a shift in medical practice towards more intensive lowering of blood pressure after clot removal to try and minimise this damage, but without evidence to support the benefits versus potential harms.”
To try to fill in the gaps in the evidence, researchers from 44 centers in China recruited 816 adults who had an acute ischaemic stroke and had high blood pressure after the clot was removed. This took place between July 2020 and March 2022. Over a third of them were female, and the group’s average age was 67.
In order to attain the target within an hour of beginning the trial and maintaining it for 72 hours, 407 participants were randomized to more intensive (target 120 mm Hg) and 409 participants were assigned to less intense (target 140-180 mm Hg) systolic blood pressure control.
With scores ranging from 0 to 1 for a positive outcome without or with symptoms but no disability, 2 to 5 for increasing levels of disability (and dependency), and 6 for death, researchers looked at how well the patients in both groups recovered.
Patients assigned to the group receiving more extensive treatment had noticeably lower scores on the scale than those assigned to the group receiving less rigorous treatment.
They experienced more early brain tissue degeneration and considerable disability at 90 days compared to the less-intensive group, but there were no appreciable differences in brain bleeds, mortality, or serious adverse events.
Due to physical constraints brought on by their stroke, patients whose blood pressure was more closely monitored also had considerably lower quality of life ratings.
Prof. Anderson stated that despite searching through the medical literature, the research team was unable to locate sufficient data to indicate the best target for blood pressure control in patients with acute ischemic stroke following blood clot removal.
“While our study has now shown intensive blood pressure control to a systolic target of less than 120 mm Hg to be harmful, the optimal level of control is yet to be defined,” he added.
Source: 10.1016/S0140-6736(22)01882-7
Image Credit: Getty
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