Associations of Early Systolic Blood Pressure Control and Outcome After Thrombolysis-Eligible Acute Ischemic Stroke: Results From the ENCHANTED Study.

Autor:	Wang X; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A)., Minhas JS; Department of Cardiovascular Sciences (J.S.M., T.G.R.), University of Leicester, United Kingdom.; National Institute for Health Research Leicester Biomedical Research Centre, United Kingdom (J.S.M., T.G.R.)., Moullaali TJ; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A).; Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (T.J.M.)., Di Tanna GL; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A)., Lindley RI; Westmead Applied Research Centre (R.I.L.), University of Sydney, NSW, Australia., Chen X; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A)., Arima H; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A).; Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Japan (H.A.)., Chen G; Department of Neurology, Xuzhou Central Hospital, China (G.C.)., Delcourt C; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A).; Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia (C.D.)., Bath PM; Stroke Trials Unit, School of Medicine, University of Nottingham, United Kingdom (P.M.B.)., Broderick JP; Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, University of Cincinnati, OH (J.P.B.)., Demchuk AM; Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada (A.M.D.)., Donnan GA; Melbourne Brain Centre, Royal Melbourne Hospital (G.A.D.), University of Melbourne, Victoria, Australia., Durham AC; Department of Cardiovascular Sciences (J.S.M., T.G.R.), University of Leicester, United Kingdom., Lavados PM; Department of Neurology and Psychiatry, Clinica Alemana de Santiago, Clinica Alemana Universidad del Desarrollo School of Medicine, Santiago, Chile (P.M.L., V.V.O.)., Lee TH; Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan (T.-H.L.)., Levi C; University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia (C.L.).; Hunter Medical Research Institute, New Lambton Heights, Australia (C.L.).; The Sydney Partnership for Health, Education, Research and Enterprise, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia (C.L.)., Martins SO; Stroke Division of Neurology Service, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil (S.O.M.)., Olavarria VV; Department of Neurology and Psychiatry, Clinica Alemana de Santiago, Clinica Alemana Universidad del Desarrollo School of Medicine, Santiago, Chile (P.M.L., V.V.O.)., Pandian JD; Department of Neurology, Christian Medical College, Ludhiana, Punjab, India (J.D.P.)., Parsons MW; Neurology Department, Royal Melbourne Hospital (M.W.P.), University of Melbourne, Victoria, Australia., Pontes-Neto OM; Department of Neurosciences and Behavioral Sciences, University of Sao Paulo, Ribeirao Preto Medical School, Brazil (O.M.P.-N.)., Ricci S; Uo Neurologia, USL Umbria 1, Sedi di Citta di Castello e Branca, Italy (S.R.)., Sato S; Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.)., Sharma VK; Yong Loo Lin School of Medicine, National University of Singapore and Division of Neurology, National University Hospital (V.K.S.)., Silva F; Neurovascular Sciences Group, Neurological Institute, Hospital Internacional de Colombia, Bucaramanga (F.S.)., Thang NH; Department of Cerebrovascular Disease, The People 115 Hospital, Ho Chi Min, Vietnam (N.H.T.)., Wang JG; Shanghai Institute for Hypertension, Rui Jin Hospital and Shanghai Jiaotong University School of Medicine, China (J.-G.W.)., Woodward M; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A).; The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)., Chalmers J; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A)., Song L; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A).; The George Institute China at Peking University Health Sciences Center, Beijing (L.S., C.S.A.)., Anderson CS; The George Institute for Global Health, University of New South Wales, Australia (X.W., T.J.M., G.L.D.T., X.C., H.A., C.D., M.W., J.C., L.S., C.S.A).; Neurology Department, Prince Royal Alfred Hospital (C.S.A.), University of Sydney, NSW, Australia.; The George Institute China at Peking University Health Sciences Center, Beijing (L.S., C.S.A.)., Robinson TG; Department of Cardiovascular Sciences (J.S.M., T.G.R.), University of Leicester, United Kingdom.; National Institute for Health Research Leicester Biomedical Research Centre, United Kingdom (J.S.M., T.G.R.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2022 Mar; Vol. 53 (3), pp. 779-787. Date of Electronic Publication: 2021 Oct 27.
DOI:	10.1161/STROKEAHA.121.034580
Abstrakt:	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.
Databáze:	MEDLINE
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