Associations of Early Systolic Blood Pressure Control and Outcome After Thrombolysis-Eligible Acute Ischemic Stroke: Results From the ENCHANTED Study

作者：Xia Wang, Jatinder S. Minhas, Tom J. Moullaali, Gian Luca Di Tanna, Richard I. Lindley, Xiaoying Chen, Hisatomi Arima, Guofang Chen, Candice Delcourt, Philip M. Bath, Joseph P. Broderick, Andrew M. Demchuk, Geoffrey A. Donnan, Alice C. Durham, Pablo M. Lavados, Tsong‐Hai Lee, Christopher Levi, Sheila Cristina Ouriques Martins, Verónica V. Olavarría, Jeyaraj Pandian, Mark Parsons, Octávio Marques Pontes‐Neto, Stefano Ricci, Shoichiro Sato, Vijay K. Sharma, Federico Silva, Trung Quoc Nguyen, Ji‐Guang Wang, Mark Woodward, John Chalmers, Lili Song, Craig S. Anderson, Thompson Robinson, on behalf of the ENCHANTED Investigators · 发表于：Stroke · 年份：2021 · DOI：10.1161/strokeaha.121.034580 · 被引用次数：37 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Traumatic Brain Injury and Neurovascular Disturbances

Background and Purpose: In thrombolysis-eligible patients with acute ischemic stroke, there is uncertainty over the most appropriate systolic blood pressure (SBP) lowering profile that provides an optimal balance of potential benefit (functional recovery) and harm (intracranial hemorrhage). We aimed to determine relationships of SBP parameters and outcomes in thrombolyzed acute ischemic stroke patients. Methods: Post hoc analyzes of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial-factorial trial of thrombolysis-eligible and treated acute ischemic stroke patients with high SBP (150–180 mm Hg) assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) alteplase and intensive (target SBP, 130–140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) treatment. All patients were followed up for functional status and serious adverse events to 90 days. Logistic regression models were used to analyze 3 SBP summary measures postrandomization: attained (mean), variability (SD) in 1–24 hours, and magnitude of reduction in 1 hour. The primary outcome was a favorable shift on the modified Rankin Scale. The key safety outcome was any intracranial hemorrhage. Results: Among 4511 included participants (mean age 67 years, 38% female, 65% Asian) lower attained SBP and smaller SBP variability were associated with favorable shift on the modified Rankin Scale (per 10 mm Hg increase: odds ratio, 0.76 [95% CI, 0.71–0.82]; P <0.001 and 0.86 [95% ...