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Effect of small vessel disease severity on blood pressure management after endovascular therapy in the BP TARGET trial.

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Title: Effect of small vessel disease severity on blood pressure management after endovascular therapy in the BP TARGET trial.
Authors: Brauner, Ran (AUTHOR), Gory, Benjamin (AUTHOR), Lapergue, Bertrand (AUTHOR), Sibon, Igor (AUTHOR), Richard, Sebastien (AUTHOR), Kyheng, Maeva (AUTHOR), Labreuche, Julien (AUTHOR), Desilles, Jean‐Philippe (AUTHOR), Blanc, Raphael (AUTHOR), Piotin, Michel (AUTHOR), Halimi, Jean‐Michel (AUTHOR), Mazighi, Mikael (AUTHOR), Maïer, Benjamin (AUTHOR), Redjem, Hocine (AUTHOR), Escalard, Simon (AUTHOR), Smajda, Stanislas (AUTHOR), Delvoye, François (AUTHOR), Hebert, Solène (AUTHOR), Obadia, Michael (AUTHOR), Sabben, Candice (AUTHOR)
Source: European Journal of Neurology. Jun2023, Vol. 30 Issue 6, p1676-1685. 10p.
Subjects: Endovascular surgery, Blood pressure, Vascular diseases, Cerebral small vessel diseases, Diastolic blood pressure, Hypertensive crisis
Abstract: Background and purpose: Acute ischaemic stroke patients with cerebral small vessel disease (CSVD), including cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs), have worse outcomes. The effect was investigated of two blood pressure strategies (intensive vs. standard) and blood pressure variability (BPV) after reperfusion according to CSVD burden in the BP TARGET trial. Methods: Patients with available magnetic resonance imaging at baseline were included. CMBs were described as absent or present and WMH severity was described according to the Fazekas classification (0–1, absent–mild; 2–3, moderate to severe). Outcomes consisted of any intracerebral hemorrhage (ICH) at 24 h and favorable outcome at 90 days (modified Rankin Scale score between 0 and 2). Results: In all, 246 patients were included. The intensive systolic blood pressure target was not associated with lower rates of ICH or favorable outcome according to CSVD subgroups (all p values >0.35). Several BPV parameters were associated with increased odds of ICH in patients with CMBs but not in patients without CMBs (diastolic blood pressure coefficient of variation, odds ratio 2.06, 95% confidence interval [CI] 1.13–3.77, in patients with ≥1 CMB vs. 0.94, 95% CI 0.68–1.31, in patients without CMBs, phet = 0.026). Several diastolic BPV parameters were associated with worse outcomes in patients with severe WMHs but not in patients without WMHs (diastolic blood pressure coefficient of variation, odds ratio 0.32, 95% CI 0.17–0.61, in patients with severe WMHs vs. 1.09, 95% CI 0.67–1.79, in patients without WMHs; phet = 0.003). Conclusion: No effect of the intensive systolic blood pressure management strategy was found on ICH occurrence or functional outcome according to CSVD burden. BPV was associated with higher odds of ICH in patients with CMBs and worse outcome in patients with moderate‐to‐severe WMHs. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Effect of small vessel disease severity on blood pressure management after endovascular therapy in the BP TARGET trial.
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  Data: <searchLink fieldCode="AR" term="%22Brauner%2C+Ran%22">Brauner, Ran</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gory%2C+Benjamin%22">Gory, Benjamin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Lapergue%2C+Bertrand%22">Lapergue, Bertrand</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sibon%2C+Igor%22">Sibon, Igor</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Richard%2C+Sebastien%22">Richard, Sebastien</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kyheng%2C+Maeva%22">Kyheng, Maeva</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Labreuche%2C+Julien%22">Labreuche, Julien</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Desilles%2C+Jean‐Philippe%22">Desilles, Jean‐Philippe</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Blanc%2C+Raphael%22">Blanc, Raphael</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Piotin%2C+Michel%22">Piotin, Michel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Halimi%2C+Jean‐Michel%22">Halimi, Jean‐Michel</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mazighi%2C+Mikael%22">Mazighi, Mikael</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Maïer%2C+Benjamin%22">Maïer, Benjamin</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Redjem%2C+Hocine%22">Redjem, Hocine</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Escalard%2C+Simon%22">Escalard, Simon</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Smajda%2C+Stanislas%22">Smajda, Stanislas</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Delvoye%2C+François%22">Delvoye, François</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hebert%2C+Solène%22">Hebert, Solène</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Obadia%2C+Michael%22">Obadia, Michael</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sabben%2C+Candice%22">Sabben, Candice</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Jun2023, Vol. 30 Issue 6, p1676-1685. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Endovascular+surgery%22">Endovascular surgery</searchLink><br /><searchLink fieldCode="DE" term="%22Blood+pressure%22">Blood pressure</searchLink><br /><searchLink fieldCode="DE" term="%22Vascular+diseases%22">Vascular diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebral+small+vessel+diseases%22">Cerebral small vessel diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Diastolic+blood+pressure%22">Diastolic blood pressure</searchLink><br /><searchLink fieldCode="DE" term="%22Hypertensive+crisis%22">Hypertensive crisis</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background and purpose: Acute ischaemic stroke patients with cerebral small vessel disease (CSVD), including cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs), have worse outcomes. The effect was investigated of two blood pressure strategies (intensive vs. standard) and blood pressure variability (BPV) after reperfusion according to CSVD burden in the BP TARGET trial. Methods: Patients with available magnetic resonance imaging at baseline were included. CMBs were described as absent or present and WMH severity was described according to the Fazekas classification (0–1, absent–mild; 2–3, moderate to severe). Outcomes consisted of any intracerebral hemorrhage (ICH) at 24 h and favorable outcome at 90 days (modified Rankin Scale score between 0 and 2). Results: In all, 246 patients were included. The intensive systolic blood pressure target was not associated with lower rates of ICH or favorable outcome according to CSVD subgroups (all p values >0.35). Several BPV parameters were associated with increased odds of ICH in patients with CMBs but not in patients without CMBs (diastolic blood pressure coefficient of variation, odds ratio 2.06, 95% confidence interval [CI] 1.13–3.77, in patients with ≥1 CMB vs. 0.94, 95% CI 0.68–1.31, in patients without CMBs, phet = 0.026). Several diastolic BPV parameters were associated with worse outcomes in patients with severe WMHs but not in patients without WMHs (diastolic blood pressure coefficient of variation, odds ratio 0.32, 95% CI 0.17–0.61, in patients with severe WMHs vs. 1.09, 95% CI 0.67–1.79, in patients without WMHs; phet = 0.003). Conclusion: No effect of the intensive systolic blood pressure management strategy was found on ICH occurrence or functional outcome according to CSVD burden. BPV was associated with higher odds of ICH in patients with CMBs and worse outcome in patients with moderate‐to‐severe WMHs. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=163567501
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        Value: 10.1111/ene.15759
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        Text: English
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      – SubjectFull: Endovascular surgery
        Type: general
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      – SubjectFull: Diastolic blood pressure
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