Background: The significance of high blood pressure variability (BPV) patients with large-vessel occlusion acute ischaemic stroke treated with endovascular treatment (EVT) is uncertain. We assessed the associations of BPV and clinical outcomes in the second Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED2/MT).
Methods: Post hoc analysis involving 816 ENCHANTED2/MT post-EVT participants randomly allocated to more-intensive (SBP target <120 mmHg) versus less-intensive (SBP target 140-180 mmHg) BP-lowering. BPV parameters were SBP standard deviation (SD), coefficient of variation (CV), and successive variation (SV) in the first 24 hours. Primary outcome was functional outcome (death and major disability [mRS 3-5]) at 90 days. Secondary outcomes were early neurological deterioration within 24 hours (END) and death at 90 days. Key safety outcome was any intracranial haemorrhage (ICH). Multivariable logistic regression models were conducted.
Results: Overall, 810 AIS patients (mean age 67 years, 38% female) were included. Higher SD, CV and SV were consistently associated with poor functional outcome (aOR 1.47, 95%CI 1.12-1.94; p=0.005; aOR 1.42, 95%CI 1.01-1.99; p=0.046; aOR 1.41, 95%CI 1.07-1.85; p=0.014, respectively) and END. However, none of the BPV parameters was associated with death or any ICH.
Conclusion: Increased BPV predicts poor function in post-EVT AIS patients.