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  • Safety and efficacy of intensive systolic blood pressure lowering after successful endovascular therapy: a post hoc analysis of the BP TARGET trial

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Ischemic stroke
Original research
Safety and efficacy of intensive systolic blood pressure lowering after successful endovascular therapy: a post hoc analysis of the BP TARGET trial
  1. Mohammad Anadani1,
  2. Benjamin Maier2,
  3. Simon Escalard3,
  4. Julien Labreuche4,
  5. Adam de Havenon5,
  6. Candice Sabben6,
  7. Bertrand Lapergue7,
  8. Eva A Mistry8,
  9. Benjamin Gory9,
  10. Alejandro M Spiotta10,
  11. Sébastien Richard11,
  12. Igor Sibon12,
  13. Jean-Philippe Desilles13,
  14. Raphael Blanc14,
  15. Michel Piotin3,
  16. Mikaël Mazighi3,15
  17. of behalf the BP TARGET study group
    1. 1 Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
    2. 2 Department of Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
    3. 3 Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
    4. 4 Univ. Lille, CHU Lille, ULR 2694-METRICS, Lille, France
    5. 5 Department of Neurology, Yale University, New Haven, Connecticut, USA
    6. 6 Department of Neurology, Fondation Rothschild Hospital, paris, France
    7. 7 Hospital Foch, Suresnes, Île-de-France, France
    8. 8 Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
    9. 9 Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
    10. 10 Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
    11. 11 Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
    12. 12 CHU de Bordeaux, Bordeaux, France
    13. 13 Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
    14. 14 Department of Interventional Neuroradiology, Fondation Rothschild, Paris, Île-de-France, France
    15. 15 Department of Neurology, GH Lariboisiere Fernand-Widal, Paris, France
    1. Correspondence to Professor Mikaël Mazighi, Departement of Interventional Neuroradiology, Fondation Rothschild Hospital, paris, France; mmazighi{at}for.paris; Dr Mohammad Anadani; anadani{at}musc.edu

    Abstract

    Background The Safety and Efficacy of Intensive Blood Pressure Lowering after Successful Endovascular Therapy in Acute Ischaemic Stroke (BP TARGET) trial demonstrated no benefit from intensive systolic blood pressure (SBP) treatment after successful reperfusion with endovascular therapy. However, it remains unknown if the response to blood pressure treatment is modified by other factors.

    Objective To carry out a post hoc analysis of the BP TARGET trial data to determine if the response to blood pressure treatment is modified by factors such as age, history of hypertension, recanalization status, location of occlusion, diabetes, hyperglycemia, or pretreatment with intravenous thrombolysis.

    Methods This is a post hoc analysis of the BP TARGET trial. Patients were divided into groups based on age, diabetes, blood glucose, site of occlusion, history of hypertension, and pretreatment with intravenous thrombolysis. The primary outcome was any intraparenchymal hemorrhage.

    Results 318 patients were included. Diabetes modified the treatment effect on favorable functional outcome (Pheteogenity=0.041). There was a trend towards benefit from intensive SBP treatment in diabetic patients (OR=2.81; 95% CI 0.88 to 8.88; p=0.08) but not in non-diabetic patients (OR=0.75; 95% 0.45 to 126; p 0.28). Age, location of occlusion, admission SBP, pretreatment with intravenous thrombolysis, and history of hypertension did not modify the effect of intensive SBP treatment on any of the outcomes.

    Conclusion The effect of SBP lowering treatment was not modified by age, location of occlusion history of hypertension, intravenous thrombolysis, and admission SBP. Diabetes modified the effect of intensive SBP lowering treatment, and there was a trend towards benefit from intensive SBP treatment in diabetic patients. This finding is hypothesis generating and requires further validation.

    • Stroke
    • Thrombectomy
    • Blood Pressure

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/jnis-2022-019130

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • Twitter @BenjaminMaierMD

      • Collaborators BP TARGET study groups: Foundation A. de Rothschild Hospital: Mikael Mazighi; Michel Piotin; Lucas Di Meglio; Hocine Redjem; Benjamin Maïer; Jean-Philippe Desilles; Simon Escalard; Stanislas Smajda; François Delvoye; Solène Hebert; Michael Obadia; Candice Sabben; Alexandre Obadia; Igor Raynouard; Erwan Morvan; Perrine Boursin; Malek Ben Maacha. Foch Hospital: Bertrand Lapergue; Arturo Consoli; Adrien Wang. Nancy Hospital: Benjamin Gory; Sebastien Richard; Gioia Mione; Lisa Humbertjean; Matthieu Bonnerot; Jean-Christophe Lacour; René Anxionnat; Romain Tonnelet; Serge Bracard. Bordeaux Hospital: Xavier Barreau; Gaultier Marnat; Jérôme Berge; Ludovic Lucas; Pauline Renou; Sabrina Debruxelles; Mathilde Poli; Sharmila Sagnier.

      • Contributors MA: study design, manuscript drafting, results interpretation, guarantor. JL: statistical analysis. MM: critical revision, study design, results interpretation, data acquisition, guarantor. Remaining authors: data acquisition, critical revision.

      • Funding Funded by the French health Ministry, PHRC -IR, AOR16037; BP-TARGET ClinicalTrials.gov: NCT03160677.

      • Competing interests RB, MP declare institutional fees for teaching presentations from Stryker, MicroVention, Balt; MM declares institutional fees for teaching presentations from Boerhinger Ingelheim, Amgen, and consulting fees from Boerhinger Ingelheim, Air liquide, Acticor Biotech; AdH declares grants from Regeneron Pharmaceuticals, Inc.; grants from AMAG Pharmaceuticals, Inc.; compensation from Integra for consultant services; and stock options in Certus.

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

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