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Low and high systolic blood pressure (SBP) at baseline is badociated with an increased risk of poor outcome in patients with acute ischemic stroke under endovascular therapy, according to new findings from a large registry study, presented at Gteborg, Sweden, at the 4th European Stroke Conference (ESOC) 2018.
Low and high systolic blood pressure (SBP) at baseline is badociated with increased risk of poor patient outcomes Stroke victims According to a new registry study, presented in Gothenburg (Sweden), at the 4th European Stroke Conference (ESOC) 2018, patients with acute ischemia undergo endovascular treatment.
The researchers found that the optimal PAS 135 mmHg increase in values above this level was badociated with an increased risk of symptomatic intracranial hemorrhage and a lower probability of successful reperfusion.
"Our results suggest that the treatment of hypertension may be useful in patients undergoing endovascular treatment and should be studied in randomized controlled trials," he said Sophie van den Berg of the Academic Medical Center of Amsterdam (Holland), who presented the study.
Data from MR CLEAN Register
This study, in particular, evaluated the relationship between PAS before endovascular treatment, on the one hand, and reperfusion, symptomatic intracranial hemorrhage and 90-day functional outcome in the MR CLEAN register (modified Rankin Scale score [mRS]), on the other hand.
The MR CLEAN Registry is an observational, prospective and multi-center study of endovascular therapy in routine clinical practice in the Netherlands.
The study included 1,488 patients undergoing endovascular treatment for a cerebrovascular accident between 2014 and 2016. The average SAP before intervention was 150 mmHg and 7% of patients had a PAS greater than 185 mmHg. Half of the patients had a history of hypertension
Relationship between PAS and functional outcome, U-shaped curve with a more favorable point at 135 mmHg
After adjustment for mRS before stroke, age, bad, The results showed that the relationship between PAS and poor functional outcome took the form of a nonlinear U-shaped curve, with the lowest probability of a poor outcome (mRS score). : 3 – 6) at systolic pressure of 135 mmHg
For PAS greater than 135 mmHg, the risk of poor results is increased by 13% for each increase of 10 mmHg (hazard ratio [HR]: 1, 13, 95% confidence interval [CI]: 1.07-1.19). For PAS less than 135 mmHg, the risk of an adverse outcome increased by 6% for each 10 mmHg decrease, although this correlation is not statistically significant (HR: 1.06, 95% CI: 0, 92 – 1.21
The relationship between PAS and mortality also showed a nonlinear U-shaped curve, the lowest mortality being observed at 135 mmHg.The risk of symptomatic intracranial hemorrhage (occurring at 6% of patients) showed a more linear relationship with PAS increase, with a mean increase in risk of 13% for each 10 mm Hg increase (HR: 1.13, 95% CI: 1.04). – 1.24).
The likelihood of successful reperfusion shows a linear relationship with the PAS, the possibilities of reperfusion were reduced with increasing pressure values van den Berg suggested that this could be caused by increased hydraulic forces badociated with higher pressures lifts that make the mechanical removal of the clot more difficult.
Patients with PAS greater than 185 mmHg had a much higher risk for a negative result, with 78% with an mRS score of 3 to 6 compared to 61% of those with pressures below 185 mmHg (HR: 1 , 63, 95% CI: 1.10 to 2.42)
Two randomized trials underway looking for stronger confirmations
van den Berg noted that a high PAS in the acute phase of ischemic stroke is badociated with an increased risk of symptomatic intracranial hemorrhage and adverse outcomes, but the extent to which PAS influences outcome after endovascular treatment in clinical practice is not well known.
"Doctors wonder if they should lower blood pressure in hypertensive patients who are entitled to endovascular treatment," said van den Berg
If lowering blood pressure in patients with hypertensive stroke who have undergone endovascular treatment both benefits are now evaluated in two randomized trials: RIGHT-2 and MR ASAP
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Reference:
4th European Conference on Accidents Stroke Vaccine (ESOC) 2018. Large Clinical Trial 2. Presented on May 18, 2018.
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