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Functional Outcomes Associated With Blood Pressure Decrease After Endovascular Thrombectomy

 Jae Wook Jung  ;  Kwang Hyun Kim  ;  Jaeseob Yun  ;  Young Dae Kim  ;  JoonNyung Heo  ;  Hyungwoo Lee  ;  Jin Kyo Choi  ;  Il Hyung Lee  ;  In Hwan Lim  ;  Soon-Ho Hong  ;  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  ;  Minyoul Baik  ;  Kyung-Yul Lee  ;  Yo Han Jung  ;  Yang-Ha Hwang  ;  Chi Kyung Kim  ;  Jae Guk Kim  ;  Chan Joo Lee  ;  Sungha Park  ;  Soyoung Jeon  ;  Hye Sun Lee  ;  Sun U Kwon  ;  Oh Young Bang  ;  Ji Hoe Heo  ;  Hyo Suk Nam 
 JAMA NETWORK OPEN, Vol.7(4) : e246878, 2024-04 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Blood Pressure ; Cerebral Hemorrhage ; Cohort Studies ; Female ; Humans ; Hypertension* / epidemiology ; Male ; Pressure ; Stroke* / surgery
Importance: The associations between blood pressure (BP) decreases induced by medication and functional outcomes in patients with successful endovascular thrombectomy remain uncertain.

Objective: To evaluate whether BP reductions induced by intravenous BP medications are associated with poor functional outcomes at 3 months.

Design, setting, and participants: This cohort study was a post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, a comparison of intensive and conventional BP management during the 24 hours after successful recanalization from June 18, 2020, to November 28, 2022. This study included 302 patients who underwent endovascular thrombectomy, achieved successful recanalization, and exhibited elevated BP within 2 hours of successful recanalization at 19 stroke centers in South Korea.

Exposure: A BP decrease was defined as at least 1 event of systolic BP less than 100 mm Hg. Patients were divided into medication-induced BP decrease (MIBD), spontaneous BP decrease (SpBD), and no BP decrease (NoBD) groups.

Main outcomes and measures: The primary outcome was a modified Rankin scale score of 0 to 2 at 3 months, indicating functional independence. Primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and mortality due to index stroke within 3 months.

Results: Of the 302 patients (median [IQR] age, 75 [66-82] years; 180 [59.6%] men), 47 (15.6%)were in the MIBD group, 39 (12.9%) were in the SpBD group, and 216 (71.5%) were in the NoBD group. After adjustment for confounders, the MIBD group exhibited a significantly smaller proportion of patients with functional independence at 3 months compared with the NoBD group (adjusted odds ratio [AOR], 0.45; 95% CI, 0.20-0.98). There was no significant difference in functional independence between the SpBD and NoBD groups (AOR, 1.41; 95% CI, 0.58-3.49). Compared with the NoBD group, the MIBD group demonstrated higher odds of mortality within 3 months (AOR, 5.15; 95% CI, 1.42-19.4). The incidence of symptomatic intracerebral hemorrhage was not significantly different among the groups (MIBD vs NoBD: AOR, 1.89; 95% CI, 0.54-5.88; SpBD vs NoBD: AOR, 2.75; 95% CI, 0.76-9.46).

Conclusions and relevance: In this cohort study of patients with successful endovascular thrombectomy after stroke, MIBD within 24 hours after successful recanalization was associated with poor outcomes at 3 months. These findings suggested lowering systolic BP to below 100 mm Hg using BP medication might be harmful.
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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) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Kwang Hyun(김광현)
Kim, Deog Young(김덕용) ORCID logo https://orcid.org/0000-0001-7622-6311
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
Yun, Jaeseob(윤제섭)
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)
Choi, Jin Kyo(최진교)
Heo, JoonNyung(허준녕)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
Hong, Soon‑Ho(홍순호)
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