Effect of blood pressure variability in the randomized controlled BP TARGET trial.

Autor: Maïer B; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.; University of Paris, Paris, France.; FHU NeuroVasc, Paris, France.; EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France., Gory B; Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, University of Lorraine, Nancy, France.; IADI, INSERM U1254, University of Lorraine, Nancy, France., Lapergue B; Division of Neurology, Department of Neurology, Stroke Center, Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France., Sibon I; Stroke Unit, CHU Bordeaux, University of Bordeaux, Bordeaux, France., Escalard S; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France., Kyheng M; University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France., Labreuche J; University of Lille, Lille University Hospital Center, EA 2694-Public Health: Epidemiology and Quality of Care, Lille, France., de Havenon A; Neurology Department, University of Utah, Salt Lake City, Utah, USA., Petersen N; Neurocritical Care and Emergency Neurology, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut, USA., Anadani M; Washington University School of Medicine in St Louis, St Louis, Missouri, USA., Gayat E; University of Paris, Paris, France.; Department of Anesthesiology, Critical Care and Burn Center, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, Paris, France.; INSERM UMR-S 942, Cardiovascular Makers in Stress Conditions, Paris, France., Boursin P; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France., Ben Maacha M; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France., Desilles JP; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.; University of Paris, Paris, France.; FHU NeuroVasc, Paris, France.; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France., Blanc R; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.; FHU NeuroVasc, Paris, France.; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France., Piotin M; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.; FHU NeuroVasc, Paris, France.; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France., Halimi JM; EA4245-Transplantation, Immunology, and Inflammation, University of Tours, Tours, France.; Nephrology Department, Tours Hospital, Tours, France.; University of Tours, Tours, France., Mazighi M; Interventional Neuroradiology Department, Adolphe de Rothschild Hospital Foundation, Paris, France.; University of Paris, Paris, France.; FHU NeuroVasc, Paris, France.; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France.
Jazyk: angličtina
Zdroj: European journal of neurology [Eur J Neurol] 2022 Mar; Vol. 29 (3), pp. 771-781. Date of Electronic Publication: 2021 Dec 17.
DOI: 10.1111/ene.15194
Abstrakt: Background and Purpose: The Blood Pressure Target in Acute Ischemic Stroke to Reduce Hemorrhage After Endovascular Therapy (BP TARGET) trial evaluated whether an intensive systolic blood pressure (SBP) target resulted in reduced rates of intracranial hemorrhage (ICH) after successful endovascular therapy (EVT) but did not assess the effect of blood pressure variability (BPV) on functional outcomes and ICH occurrence. We sought to evaluate this question in the BP TARGET trial.
Methods: We performed a post hoc analysis of the BP TARGET trial and included patients with at least 50% of blood pressure (BP) recordings during the first 24 h after EVT. BPV parameters were SBP and diastolic BP (DBP) coefficient of variation (CV), standard deviation (SD), maximum-minimum (max-min), successive variation (SV), and time rate. The primary outcome was favorable functional outcome (3-month modified Rankin Scale between 0 and 2); the secondary outcome was the rate of ICH at 24 h.
Results: We included 290 patients (mean number of BP measures = 30.4, SD = 8.0). BPV parameters (SBP SD , SBP max-min , SBP CV ) were higher in the intensive SBP target group. Only DBP BPV parameters were associated with worse functional outcomes in the unadjusted model (DBP SD , DBP max-min , DBP CV , and DBP SV ), but not after adjustment. Higher SBP max-min was associated with worse functional outcomes in Thrombolysis in Cerebral Infarction 2B patients (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.38-1.02), but not in patients with complete reperfusion (OR = 1.27, 95% CI = 0.80-2.02, p for heterogeneity (p het =0.037). None of the BPV parameters was associated with ICH, regardless of the randomization group or the reperfusion grade.
Conclusions: BPV was significantly higher in the intensive SBP target group but was not associated with functional outcome or ICH.
(© 2021 European Academy of Neurology.)
Databáze: MEDLINE
Externí odkaz: