Intensive Blood Pressure Lowering With Intravenous Thrombectomy for Acute Ischemic Stroke Did Not Improve Functional Outcomes

In results from the ENCHANTED trial (NCT01422616), presented at the International Stroke Conference (ISC) in Honolulu, Hawaii and published in The Lancet, patients provided intensive lowering of systolic blood pressure (SBP) did not have better functional outcomes than those who received the standard-of-care lowering of SPB. Intensive blood pressure management was defined as lowering SPB to 130 to 140 mm Hg over an hour and standard-of-care blood pressure management was lowering SBP to less than 180 mm Hg over 72 hours. For the 1,081 patients who received intensive management, the mean SBP was 144.3 mm Hg compared with 149.3 mm Hg for the 1,115 who received standard-of-care treatment (P < .0001). After 90 days, the functional outcomes as measured by the modified Ranking Scale (mRS) did not differ significantly between the 2 groups (unadjusted odds ratio [OR] 1.01, 95% CI: 0·87-1·17, P = .870).  

In patients given intensive SBP management, the rate of intracranial hemorrhage was 18.7% compared with 22% of patients who received standard-of-care treatment (OR .75, P = .0137); the number of serious adverse events did not differ between groups, however (P = .1412). 

During the presentation at the ISC, it was noted that the overall difference in blood pressure between the groups was small, which may have affected the power of the study and that this may have been due to not including patients who had SBP more than 185 mm Hg that made them ineligible for treatment with alteplase. Further, although the study was international and multisite, the majority of the patients were Chinese or Asian and this lack of heterogeneity may also have affected the overall results. 

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