Blood Pressure in Acute Stroke: Still No Answer for Management.

Abstract

See related article, p 1869 Whether intravenous or endovascular stroke therapy should be withhold in patients with acute ischemic stroke with blood pressure (BP) levels above certain thresholds is one of the major unresolved issues in acute stroke management. The post hoc analysis of data of the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) published in Stroke adds important new information about the risks and benefits of endovascular therapy (EVT) in acute stroke patients with different BP levels at baseline. Mulder et al1 analyzed BP and the effect of EVT in the MR CLEAN study and showed that the effectiveness of EVT is similar in the entire range of baseline BP of the included patients. Furthermore, BP and EVT did not interact with the occurrence of symptomatic intracerebral hemorrhage (ICH) or other safety parameters. However, there was an independent association between increasing systolic BP (SBP) levels and the risk of symptomatic ICH in the subgroup of patients with SBP>120 mm Hg, as shown previously.2,3 In addition, the authors found a similar J-shaped relationship of admission BP and functional outcome in patients who underwent EVT and their controls who received intravenous thrombolysis (IVT). The information gained from MR CLEAN provides an important message for clinicians treating patients with acute ischemic strokes with proximal vessel occlusion in the anterior circulation: BP, whatever its value is, does not …