| Blood Pressure Post-Ischemic Stroke | |
|---|---|
| (ENCHANTED) Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke: an international, randomised, open-label, blinded-endpoint, phase 3 trial _____ An RCT assigning post-thrombolysis patients to intensive (SBP 130-140) or guideline (SBP <180) BP control. Results showed no difference in 90-day mRS or SAE between groups, but the intensive group did experience fewer ICH | LINK |
| Association of Elevated Blood Pressure Levels with Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis _____ A meta-analysis of studies involving stroke patients who received thrombolysis, demonstrating that those with high pre- and post-treatment SBP have greater odds of developing sICH, and lower odds of functional independence at 90 days | LINK |
Note: Several older observational studies suggest that lower post-stroke blood pressures may be associated with worse neurologic outcomes. For more information on these studies, the supplemental materials of the 2019 AHA Acute Ischemic Stroke Guidelines are helpful (Supplement 1, Table XXIX)
| Blood Pressure Post-Intracranial Hemorrhage | |
|---|---|
| (ATACH-2) Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage _____ A RCT of ICH patients assigned to intensive (SBP 110-139) vs standard (SBP 140-179) BP targets using nicardipine. The trial was stopped early due to futility as no difference in death or disability was noted between groups, though the intensive group did have a higher rate of renal adverse events. | LINK |
| (INTERACT-2) Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage _____ A RCT of ICH patients assigned to intensive (SBP <140) or standard (SBP <180) BP targets using any medication. There was no significant difference in death or disability between the groups, but ordinal analysis demonstrated a reduced 90 day mRS in the intensive group. | LINK |
| Blood pressure control and clinical outcomes in acute intracerebral hemorrhage: a preplanned pooled analysis of individual participant data _____ A pooled analysis of individual patient-level data from ATACH-2 and INTERACT-2, finding that early achieved and smooth control of blood pressure is associated with improved functional outcomes and reduced hematoma expansions. | LINK |
Note: These studies as well as several more studies & analyses are included within the citations of the 2022 AHA Guidelines on management of spontaneous intracerebral hemorrhage.