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Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke: The OPTIMAL-BP Randomized Clinical Trial

Authors
 Hyo Suk Nam  ;  Young Dae Kim  ;  JoonNyung Heo  ;  Hyungwoo Lee  ;  Jae Wook Jung  ;  Jin Kyo Choi  ;  Il Hyung Lee  ;  In Hwan Lim  ;  Soon-Ho Hong  ;  Minyoul Baik  ;  Byung Moon Kim  ;  Dong Joon Kim  ;  Na-Young Shin  ;  Bang-Hoon Cho  ;  Seong Hwan Ahn  ;  Hyungjong Park  ;  Sung-Il Sohn  ;  Jeong-Ho Hong  ;  Tae-Jin Song  ;  Yoonkyung Chang  ;  Gyu Sik Kim  ;  Kwon-Duk Seo  ;  Kijeong Lee  ;  Jun Young Chang  ;  Jung Hwa Seo  ;  Sukyoon Lee  ;  Jang-Hyun Baek  ;  Han-Jin Cho  ;  Dong Hoon Shin  ;  Jinkwon Kim  ;  Joonsang Yoo  ;  Kyung-Yul Lee  ;  Yo Han Jung  ;  Yang-Ha Hwang  ;  Chi Kyung Kim  ;  Jae Guk Kim  ;  Chan Joo Lee  ;  Sungha Park  ;  Hye Sun Lee  ;  Sun U Kwon  ;  Oh Young Bang  ;  Craig S Anderson  ;  Ji Hoe Heo  ;  OPTIMAL-BP Trial Investigators 
Citation
 JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol.330(9) : 832-842, 2023-09 
Journal Title
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
ISSN
 0098-7484 
Issue Date
2023-09
MeSH
Acute Disease ; Aged ; Antihypertensive Agents* / adverse effects ; Antihypertensive Agents* / therapeutic use ; Blood Pressure* / drug effects ; Cerebral Hemorrhage / etiology ; Endovascular Procedures ; Female ; Functional Status* ; Humans ; Ischemic Stroke* / drug therapy ; Ischemic Stroke* / surgery ; Male ; Stroke / therapy ; Thrombectomy* / adverse effects ; Thrombectomy* / methods ; Treatment Outcome
Keywords
ASSOCIATION ; BRAIN EDEMA ; GUIDELINES ; IMPORTANT DIFFERENCE ; INDIVIDUAL PATIENT DATA ; MANAGEMENT ; OUTCOMES ; SCORE ; THERAPY
Abstract
Importance Optimal blood pressure (BP) control after successful reperfusion with endovascular thrombectomy (EVT) for patients with acute ischemic stroke is unclear.,Objective To determine whether intensive BP management during the first 24 hours after successful reperfusion leads to better clinical outcomes than conventional BP management in patients who underwent EVT.,Design, Setting, and Participants Multicenter, randomized, open-label trial with a blinded end-point evaluation, conducted across 19 stroke centers in South Korea from June 2020 to November 2022 (final follow-up, March 8, 2023). It included 306 patients with large vessel occlusion acute ischemic stroke treated with EVT and with a modified Thrombolysis in Cerebral Infarction score of 2b or greater (partial or complete reperfusion).,Interventions Participants were randomly assigned to receive intensive BP management (systolic BP target <140 mm Hg; n=155) or conventional management (systolic BP target 140-180 mm Hg; n=150) for 24 hours after enrollment. Main Outcomes and MeasuresThe primary outcome was functional independence at 3 months (modified Rankin Scale score of 0-2). The primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and death related to the index stroke within 3 months.,Results The trial was terminated early based on the recommendation of the data and safety monitoring board, which noted safety concerns. Among 306 randomized patients, 305 were confirmed eligible and 302 (99.0%) completed the trial (mean age, 73.0 years; 122 women [40.4%]). The intensive management group had a lower proportion achieving functional independence (39.4%) than the conventional management group (54.4%), with a significant risk difference (-15.1% [95% CI, -26.2% to -3.9%]) and adjusted odds ratio (0.56 [95% CI, 0.33-0.96]; P=.03). Rates of symptomatic intracerebral hemorrhage were 9.0% in the intensive group and 8.1% in the conventional group (risk difference, 1.0% [95% CI, -5.3% to 7.3%]; adjusted odds ratio, 1.10 [95% CI, 0.48-2.53]; P=.82). Death related to the index stroke within 3 months occurred in 7.7% of the intensive group and 5.4% of the conventional group (risk difference, 2.3% [95% CI, -3.3% to 7.9%]; adjusted odds ratio, 1.73 [95% CI, 0.61-4.92]; P=.31).,Conclusions and Relevance Among patients who achieved successful reperfusion with EVT for acute ischemic stroke with large vessel occlusion, intensive BP management for 24 hours led to a lower likelihood of functional independence at 3 months compared with conventional BP management. These results suggest that intensive BP management should be avoided after successful EVT in acute ischemic stroke.,Trial Registration ClinicalTrials.gov Identifier: NCT04205305,
Full Text
https://jamanetwork.com/journals/jama/fullarticle/2808993
DOI
10.1001/jama.2023.14590
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Jinkwon(김진권) ORCID logo https://orcid.org/0000-0003-0156-9736
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Baik, Minyoul(백민렬)
Shin, Na Young(신나영)
Yoo, Joon Sang(유준상) ORCID logo https://orcid.org/0000-0003-1169-6798
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Lee, Ilhyung(이일형)
Lee, Chan Joo(이찬주) ORCID logo https://orcid.org/0000-0002-8756-409X
Lee, Hyung Woo(이형우)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Lim, In Hwan(임인환)
Jung, Yo Han(정요한) ORCID logo https://orcid.org/0000-0002-3048-4718
Jung, Jae Wook(정재욱)
Heo, JoonNyung(허준녕)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
Hong, Soon‑Ho(홍순호)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/197725
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