Intensive versus guideline-recommended blood pressure reduction in acute lacunar stroke with intravenous thrombolysis therapy: The ENCHANTED trial.

Abstract

BACKGROUND AND PURPOSE:

This was an investigation of the differential effects of early intensive versus guideline-recommended blood pressure (BP) lowering between lacunar and non-lacunar acute ischaemic stroke (AIS) in the BP arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

METHODS:

In 1,632 participants classified as having definite or probable lacunar (n = 454 [27.8%]) or non-lacunar AIS according to pre-specified definitions based upon clinical and adjudicated imaging findings, mean BP changes over days 0-7 were plotted, and systolic BP differences by treatment between subgroups were estimated in generalized linear models. Logistic regression models were used to estimate the BP treatment effects on 90-day outcomes (primary, an ordinal shift of modified Rankin scale scores) across lacunar and non-lacunar AIS after adjustment for baseline covariables.

RESULTS:

Most baseline characteristics, acute BP and other management differed between lacunar and non-lacunar AIS, but mean systolic BP differences by treatment were comparable at each time point (all pinteraction  > 0.12) and over 24 h post-randomization (-5.5, 95% CI -6.5, -4.4 mmHg in lacunar AIS vs. -5.6, 95% CI -6.3, -4.8 mmHg in non-lacunar AIS, pinteraction  = 0.93). The neutral effect of intensive BP lowering on functional outcome and the beneficial effect on intracranial haemorrhage were similar for the two subgroups (all pinteraction  > 0.19).

CONCLUSIONS:

There were no differences in the treatment effect of early intensive versus guideline-recommended BP lowering across lacunar and non-lacunar AIS.

• Authors: Zien Zhou, Chao Xia, Cheryl Carcel, Sohei Yoshimura, Xia Wang, Candice Delcourt, Alejandra Malavera, Xiaoying Chen, Grant Mair, Mark Woodward, John Chalmers, Andrew M Demchuk, Richard I Lindley, Thompson G Robinson, Mark W Parsons, Joanna M Wardlaw, Craig S Anderson
• Journal: European journal of neurology (Eur J Neurol) Vol. 28 Issue 3 Pg. 783-793 (03 2021) ISSN: 1468-1331 [Electronic] England
• PMID: 33069172 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 European Academy of Neurology.

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Blood Pressure
• Brain Ischemia (drug therapy)
• Fibrinolytic Agents (therapeutic use)
• Humans
• Stroke (drug therapy)
• Stroke, Lacunar (drug therapy)
• Thrombolytic Therapy
• Tissue Plasminogen Activator (therapeutic use)
• Treatment Outcome