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Vascular neurology
Blood pressure reduction and outcome after endovascular therapy: a secondary analysis of the BEST study
  1. Mohammad Anadani1,2,
  2. Adam de Havenon3,
  3. Shadi Yaghi4,
  4. Tapan Mehta5,
  5. Niraj Arora6,
  6. Amy Kathryn Starosciak7,8,
  7. Felipe De Los Rios La Rosa9,
  8. James Siegler10,
  9. Akshitkumar M Mistry11,
  10. Rohan Chitale11,
  11. Alejandro M Spiotta12,
  12. Georgios Tsivgoulis13,
  13. Pooja Khatri14,
  14. Eva A Mistry15
  1. 1 Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
  2. 2 Department of Neurology, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
  3. 3 Department of Neurology, University of Utah, Salt Lake City, Utah, USA
  4. 4 Department of Neurology, NYU Langone Health, Brooklyn, New York, USA
  5. 5 Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
  6. 6 Department of Neurology, University of Missouri, Columbia, South Carolina, USA
  7. 7 Neuroscience Center - 2 Clarke, Baptist Hospital, Miami, Florida, USA
  8. 8 Center for Research, Baptist Health South Florida, Coral Gables, Florida, USA
  9. 9 Baptist Health South Florida, Coral Gables, Florida, USA
  10. 10 Department of Neurology, Cooper University Health, Camden, New Jersey, USA
  11. 11 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  12. 12 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  13. 13 Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Athens, Greece
  14. 14 Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
  15. 15 Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Eva A Mistry, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; eva.a.mistry{at}vumc.org

Abstract

Background Elevated systolic blood pressure (SBP) in the acute phase after endovascular therapy (EVT) is associated with worse outcome. However, the association between systolic blood pressure reduction (SBPr) and the outcome of EVT is not well understood.

Objective To determine the association between SBPr and clinical outcomes after EVT in a prospective multicenter cohort.

Methods A post hoc analysis of the Blood Pressure after Endovascular Stroke Therapy (BEST) prospective observational cohort study was carried out. SBPr was defined as the absolute difference between admission SBP and mean SBP in the first 24 hours after EVT. Logistic regression was used to assess the association between SBPr and poor functional outcome (modified Rankin Scale score 3–6) at 90 days.

Results A total of 259/433 (58.5%) patients had poor outcome. SBPr was higher in the poor outcome group than in the good outcome group (26.6±27.4 vs 19.0±22.3 mm Hg; p<0.001). However, in adjusted models, SBPr was not independently associated with poor outcome (OR=1.00 per 1 mm Hg increase, 95% CI 0.99 to 1.01) or death (OR=0.9 per 1 mm Hg increase; 95% CI 0.98 to 1.00). No association remained when SBPr was divided into tertiles. Subgroup analyses based on history of hypertension, revascularization status, and antihypertensive treatment yielded similar results.

Conclusion The reduction in baseline SBP following EVT was not associated with poor functional outcomes. Most of the cohort (88%) achieved successful recanalization, and therefore, these results mainly apply to patients with successful recanalization.

  • thrombectomy
  • blood pressure
  • stroke

Data availability statement

Data are available upon reasonable request. Data sharing statement: Additional data from this project can be acquired by contacting the corresponding author.

https://doi.org/10.1136/neurintsurg-2020-016494

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    Data availability statement

    Data are available upon reasonable request. Data sharing statement: Additional data from this project can be acquired by contacting the corresponding author.

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    Footnotes

    • Twitter @JimSiegler

    • MA and AdH contributed equally.

    • Contributors All authors provided a substantial contribution to the conception and design of the studies and/or the acquisition and/or the analysis of the data and/or the interpretation of the data. They have drafted the work or revised it for significant intellectual content and approved the final version of the manuscript. They agree to be accountable for all aspects of the work, including its accuracy and integrity.

    • Funding Supported by the Society of Vascular and Interventional Neurology and the University of Cincinnati Gardner Neuroscience Institute pilot research grants. EAM reports a research grant from NIH/NINDS (K23NS113858).

    • Competing interests EAM reports grants from the Society of Vascular and Interventional Neurology, University of Cincinnati Gardner Neuroscience Institute, and Vanderbilt Faculty Research Scholar Program. AdH reports a research grant from NIH/NINDS (K23NS105924).

    • Provenance and peer review Not commissioned; externally peer reviewed.