A new study published in the “Journal of Atherosclerosis and Thrombosis” suggests the efficacy of antihypertensive drugs in potentially altering the impact of systolic blood pressure variability (SBPV) on clinical outcomes for patients experiencing an acute ischemic stroke (AIS) after undergoing successful endovascular treatment (EVT). The research sheds light on the complexities of post-stroke care and could influence the management of blood pressure in the critical period following a stroke.

DOI: 10.5551/jat.64637

Blood Pressure in Focus: The Study on AIS-LVO Patients Post-EVT

By retrospectively analyzing a cohort of 214 consecutive patients who suffered from AIS due to large-vessel occlusion (LVO) and underwent successful recanalization through EVT, researchers sought to determine the link between SBPV in the first 24 hours post-treatment and the patients’ long-term recovery. Notably, 63.6% of these patients were administered antihypertensive drugs.

Systolic Blood Pressure Variability: A Marker for Prognosis

Poor outcomes were defined as scoring 3-6 on the modified Rankin Scale, which is used to measure the degree of disability or dependence in daily activities of people who have suffered a stroke, at 90 days post-event. Researchers utilized eight different statistical measures to calculate SBPV, finding significant differences in variability between patients with good outcomes versus those with poor outcomes.

Antihypertensive Drugs: A Potentially Protective Factor

Through logistic regression analysis, which included odds ratios ranging from 1.031 to 1.282, all SBPV indicators were consistently affiliated with unfavorable patient results amongst those not taking antihypertensive drugs. However, for patients who were on antihypertensive medication, no association was observed between SBPV and poor outcomes.

Efficacy Assessment: Analyzing Predictive Models

The validity of these findings is further reinforced by the comparison of outcome prediction models – those adjusted for antihypertensive drug use demonstrated a larger area under the curve (AUC), ranging between 0.774 and 0.783, compared with models not adjusted for such drugs, which had AUCs between 0.739 and 0.754.

Implications and Interpretations

The study, led by Dr. Li Jing and colleagues from the Department of Neurology at the General Hospital of Northern Theater Command, suggests that managing systolic blood pressure variations through the use of antihypertensive drugs may have beneficial effects on the clinical outcomes of patients with AIS-LVO following successful recanalization post-EVT.

The Context of Blood Pressure in Stroke Management

Blood pressure management is a cornerstone in the management of both acute stroke and secondary prevention. The delicate balance healthcare professionals strive to maintain between too high and too low blood pressure levels is crucial for optimizing brain perfusion without exacerbating the risk of further bleeding or infarction.

Further Research and Clinical Practice Adjustments

While this study’s findings are substantial, they echo the need for additional research to explore the mechanisms by which antihypertensive drugs may alter the impact of SBPV on stroke outcomes. Nevertheless, these preliminary results may prompt revisions in clinical guidelines, pushing for an individualized approach towards antihypertensive drug use in the immediate period following a stroke.

Conclusion

In conclusion, this study opens new avenues for targeted blood pressure management in stroke recovery, highlighting that the utilization of antihypertensive medication may have a mitigating effect on the negative outcomes associated with SBPV in stroke patients.

References

1. Jing, L., Bai-Jun, L., Ying-Jia, W., Yu, C., & Hui-Sheng, C. (2024). Antihypertensive Drugs Affect the Association of Systolic Blood Pressure Variability with Outcomes in Patients with Acute Stroke who had Successful Recanalization after Endovascular Treatment. Journal of Atherosclerosis and Thrombosis. doi:10.5551/jat.64637

2. Manning, L.S., Rothwell, P.M., Potter, J.F., & Robinson, T.G. (2015). Prognostic Significance of Short-term Blood Pressure Variability in Acute Stroke: Systematic Review. Stroke, 46(9), 2482-2490.

3. Delgado-Mederos, R., Ribo, M., Rovira, A., Rubiera, M., Munuera, J., Santamarina, E., … & Molina, C.A. (2009). Prognostic Significance of Blood Pressure Variability After Thrombolysis in Acute Stroke. Neurology, 73(16), 1273-1278.

4. Iadecola, C., & O’Brien, J. T. (2020). Hypertension, Angiotensin Receptor Blockers and the Brain: A Twinkle in the Darkness?. Journal of Clinical Investigation, 130(11), 5737-5740.

5. Rothwell, P. M. (2010). Limitations of the Usual Blood Pressure Hypothesis and Importance of Variability, Instability, and Episodic Hypertension. Lancet, 375(9718), 938-948.

Keywords

1. Blood pressure variability and stroke
2. Antihypertensive drugs effectiveness
3. Acute ischemic stroke treatment
4. Endovascular treatment success
5. Stroke outcome prediction models