Personalized Blood Pressure Targets After Stroke Thrombectomy Improved 90-Day Recovery in HOPE Trial
KEY TAKEAWAYS
- The personalized strategy reduced hemorrhagic transformation without increasing symptomatic intracranial hemorrhage or mortality.
- Investigators state the findings support further study but should be interpreted cautiously because the trial ended early.
Adults with acute ischemic stroke who received personalized systolic blood pressure (BP) management after successful endovascular thrombectomy were more likely to achieve functional independence at 90 days than those treated with current guideline-based BP targets, according to findings from the phase 3 HOPE (NCT04892511) trial. The reperfusion-guided strategy also reduced hemorrhagic transformation without increasing major safety events, suggesting that post-thrombectomy BP management tailored to angiographic reperfusion may improve outcomes after large-vessel occlusion stroke.
HOPE was an investigator-initiated, multicenter, randomized, open-label trial with blinded outcome assessment conducted at 11 stroke centers in Spain. The study included 440 adults with anterior circulation large-vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2b) after endovascular therapy. Participants were randomized to reperfusion-guided systolic BP targets for 72 hours (100–140 mm Hg for mTICI 2c/3 and 140–160 mm Hg for mTICI 2b) or standard guideline-directed management with systolic BP <180 mm Hg. The primary endpoint was functional independence, defined as a modified Rankin Scale score of 0 to 2 at 90 days.
What the Trial Revealed
- 60.0% of participants in the personalized BP group achieved functional independence versus 47.1% with standard care (absolute risk difference, 13.3%; P=.005).
- Hemorrhagic transformation occurred in 22.3% versus 31.6% of participants, respectively (OR, 0.62; 95% CI, 0.41–0.95).
- Rates of symptomatic intracranial hemorrhage (3.5% vs 3.9%), 90-day mortality (15.4% vs 15.6%), and serious adverse events were similar between groups.
The investigators noted that the study was stopped early because of funding limitations and enrolled fewer participants than planned, with most achieving near-complete reperfusion. They concluded that the results warrant confirmation in larger trials before changing routine post-thrombectomy BP management.
Source
Camps-Renom P, Guasch-Jiménez M, Álvarez-Cienfuegos J, et al; HOPE Study Group. Personalized blood pressure targeting after endovascular therapy for acute ischemic stroke: A randomized clinical trial. Published online June 8, 2026. JAMA Neurol. doi:10.1001/jamaneurol.2026.1706.