A large stroke study found that intensively lowering blood pressure after blood clot removal worsens recovery. The results of the trial, which was stopped early because of the significance of the findings, were presented at a late session of the World Stroke Congress and published simultaneously in Lancet.
Professor Craig Anderson, Director of Global Brain Health at the George Institute for Global Health, said the rapid onset of this effect suggests that a more aggressive approach is preventing blood flow to the affected area from being restored.
“Our study suggests that this increasingly common treatment strategy should now be avoided clinical practice” he said.
About 85 percent of strokes are ischemic strokes, caused by loss of blood flow to an area of the brain due to a blockage in a blood vessel, resulting in loss of neurological function.
Endovascular thrombectomy is an increasingly used nonsurgical treatment for ischemic stroke in which microcatheters, or thin tubes visible on X-rays, are inserted into the blood clot to dissolve it.
“A potential drawback of this widely used and effective treatment is that rapid restoration of blood supply to an area that has been deprived of oxygen for a period of time can cause tissue damage known as reperfusion injury” said Professor Anderson.
“This has led to a shift in medical practice toward more intensive blood pressure lowering after thrombus removal to try to minimize this harm, but without evidence to support the benefits against the potential harm.”
To try to address the evidence gap, researchers recruited 816 adults with acute ischemic stroke who had elevated blood pressure after clot removal from 44 centers in China between July 2020 and March 2022. Their average age was 67, and slightly more than a third were women. .
407 were classified as more intensive (meth
The researchers looked at how well patients in both groups recovered according to a standard measure of disability, ranging from 0-1 for a good outcome with no or symptoms but no disability, scores of 2-5 indicating increasing levels of disability (and dependence) , and a score of 6 means death.
Patients in the more intensive treatment group had significantly worse scores on the scale compared to those who received less intensive treatment.
Compared with the less intensive group, they had earlier deterioration of brain tissue and significant disability at 90 days, but there were no significant differences in cerebral bleeding, mortality or serious side effects.
Patients whose blood pressure was more intensively controlled also rated their quality of life as significantly worse because of limitations in physical abilities as a result of the stroke.
Professor Anderson said that after examining the medical literature, the research team could not find enough strong evidence to recommend an ideal target for blood pressure control after a blood test. clot removal in patients with acute ischemic stroke.
“While our research has now shown the intensity blood pressure control to a target systolic value of less than 120 mm Hg. harmful, the optimal level of control has yet to be determined,” he said.
Children with severe strokes may do better if treatment includes mechanical removal of the blood clot
Intensive blood pressure control after endovascular thrombectomy for acute ischemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded, randomized controlled trial with an endpoint of Lancet (2022). DOI: 10.1016/S0140-6736(22)01882-7
George Institute for Global Health
Citation: Large stroke trial finds intensive blood pressure lowering after clot removal impairs recovery (2022, October 28) Retrieved October 28, 2022 from https://medicalxpress.com/news/2022-10-large-trial-intensive -blood-pressure.html
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