OPTIMAL-BP
Trial question
What is the role of intensive BP management in patients with AIS treated with endovascular thrombectomy?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
40.0% female
60.0% male
N = 302
302 patients (122 female, 180 male)
Inclusion criteria: patients with large vessel occlusion AIS treated with endovascular thrombectomy
Key exclusion criteria: SBP < 140 mmHg after endovascular thrombectomy; any contraindication to the use of antihypertensive medications; symptomatic ICH evident during or immediately after endovascular thrombectomy; serious medical or surgical illness; prestroke disability
Interventions
N=155 intensive management (monitoring and treatment to achieve SBP target < 140 mmHg at 24 hours)
N=147 conventional management (monitoring and treatment to achieve SBP target of 140-180 mmHg at 24 hours)
Primary outcome
Functional independence at 3 months
39.4
54.4
54.4 %
40.8 %
27.2 %
13.6 %
0.0 %
Intensive
management
Conventional
management
Significant
decrease ▼
NNT = 6
Significant decrease in functional independence at 3 months (39.4% vs. 54.4%; OR 0.56, 95% CI 0.33 to 0.96)
Secondary outcomes
No significant difference in mean NIHSS score at 24 hours (11.56 points vs. 9.59 points; OR 1.05, 95% CI -0.2 to 2.3)
No significant difference in successful reperfusion at 24 hours (90.4% vs. 93.6%; OR 0.66, 95% CI 0.26 to 1.65)
Significant increase in malignant cerebral edema (7.7% vs. 1.3%; OR 7.88, 95% CI 1.57 to 39.39)
Safety outcomes
No significant differences in symptomatic intracerebral hemorrhage, death related to index stroke within 3 months.
Conclusion
In patients with large vessel occlusion AIS treated with endovascular thrombectomy, intensive management was inferior to conventional management with respect to functional independence at 3 months.
Reference
Hyo Suk Nam, Young Dae Kim, JoonNyung Heo et al. Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke: The OPTIMAL-BP Randomized Clinical Trial. JAMA. 2023 Sep 5;330(9):832-842.
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