Medical Dialogues
  • Dermatology
Login Register
This site is intended for healthcare professionals only
Login Register
  • MD Brand Connect
  • Vaccine Hub
  • MDTV
    • Breaking News
    • Medical News Today
    • Health News Today
    • Latest
    • Journal Club
    • Medico Legal Update
    • Latest Webinars
    • MD Shorts
    • Health Dialogues
  • Fact Check
  • Health Dialogues
Medical Dialogues
  • Medical News & Guidelines
      • Anesthesiology
      • Cardiology and CTVS
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endocrinology
      • ENT
      • Gastroenterology
      • Medicine
      • Nephrology
      • Neurology
      • Obstretics-Gynaecology
      • Oncology
      • Ophthalmology
      • Orthopaedics
      • Pediatrics-Neonatology
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
      • Laboratory Medicine
      • Diet
      • Nursing
      • Paramedical
      • Physiotherapy
  • Health news
      • Doctor News
      • Government Policies
      • Hospital & Diagnostics
      • International Health News
      • Medical Organization News
      • Medico Legal News
      • NBE News
      • NMC News
  • Fact Check
      • Bone Health Fact Check
      • Brain Health Fact Check
      • Cancer Related Fact Check
      • Child Care Fact Check
      • Dental and oral health fact check
      • Diabetes and metabolic health fact check
      • Diet and Nutrition Fact Check
      • Eye and ENT Care Fact Check
      • Fitness fact check
      • Gut health fact check
      • Heart health fact check
      • Kidney health fact check
      • Medical education fact check
      • Men's health fact check
      • Respiratory fact check
      • Skin and hair care fact check
      • Vaccine and Immunization fact check
      • Women's health fact check
  • AYUSH
    • Ayurveda
    • Homeopathy
    • Siddha
    • Unani
    • Yoga
  • State News
      • Andaman and Nicobar Islands
      • Andhra Pradesh
      • Arunachal Pradesh
      • Assam
      • Bihar
      • Chandigarh
      • Chattisgarh
      • Dadra and Nagar Haveli
      • Daman and Diu
      • Delhi
      • Goa
      • Gujarat
      • Haryana
      • Himachal Pradesh
      • Jammu & Kashmir
      • Jharkhand
      • Karnataka
      • Kerala
      • Ladakh
      • Lakshadweep
      • Madhya Pradesh
      • Maharashtra
      • Manipur
      • Meghalaya
      • Mizoram
      • Nagaland
      • Odisha
      • Puducherry
      • Punjab
      • Rajasthan
      • Sikkim
      • Tamil Nadu
      • Telangana
      • Tripura
      • Uttar Pradesh
      • Uttrakhand
      • West Bengal
  • Medical Education
      • Ayush Education News
      • Dentistry Education News
      • Medical Admission News
      • Medical Colleges News
      • Medical Courses News
      • Medical Universities News
      • Nursing education News
      • Paramedical Education News
      • Study Abroad
  • Industry
      • Health Investment News
      • Health Startup News
      • Medical Devices News
      • Pharma News
      • Pharmacy Education News
      • Industry Perspective
  • MDTV
      • Health Dialogues MDTV
      • Health News today MDTV
      • Latest Videos MDTV
      • Latest Webinars MDTV
      • MD shorts MDTV
      • Medical News Today MDTV
      • Medico Legal Update MDTV
      • Top Videos MDTV
      • Health Perspectives MDTV
      • Journal Club MDTV
      • Medical Dialogues Show
This site is intended for healthcare professionals only
LoginRegister
Medical Dialogues
LoginRegister
  • Home
  • Medical news & Guidelines
    • Anesthesiology
    • Cardiology and CTVS
    • Critical Care
    • Dentistry
    • Dermatology
    • Diabetes and Endocrinology
    • ENT
    • Gastroenterology
    • Medicine
    • Nephrology
    • Neurology
    • Obstretics-Gynaecology
    • Oncology
    • Ophthalmology
    • Orthopaedics
    • Pediatrics-Neonatology
    • Psychiatry
    • Pulmonology
    • Radiology
    • Surgery
    • Urology
    • Laboratory Medicine
    • Diet
    • Nursing
    • Paramedical
    • Physiotherapy
  • Health news
    • Doctor News
    • Government Policies
    • Hospital & Diagnostics
    • International Health News
    • Medical Organization News
    • Medico Legal News
    • NBE News
    • NMC News
  • Fact Check
    • Bone Health Fact Check
    • Brain Health Fact Check
    • Cancer Related Fact Check
    • Child Care Fact Check
    • Dental and oral health fact check
    • Diabetes and metabolic health fact check
    • Diet and Nutrition Fact Check
    • Eye and ENT Care Fact Check
    • Fitness fact check
    • Gut health fact check
    • Heart health fact check
    • Kidney health fact check
    • Medical education fact check
    • Men's health fact check
    • Respiratory fact check
    • Skin and hair care fact check
    • Vaccine and Immunization fact check
    • Women's health fact check
  • AYUSH
    • Ayurveda
      • Ayurveda Giuidelines
      • Ayurveda News
    • Homeopathy
      • Homeopathy Guidelines
      • Homeopathy News
    • Siddha
      • Siddha Guidelines
      • Siddha News
    • Unani
      • Unani Guidelines
      • Unani News
    • Yoga
      • Yoga Guidelines
      • Yoga News
  • State News
    • Andaman and Nicobar Islands
    • Andhra Pradesh
    • Arunachal Pradesh
    • Assam
    • Bihar
    • Chandigarh
    • Chattisgarh
    • Dadra and Nagar Haveli
    • Daman and Diu
    • Delhi
    • Goa
    • Gujarat
    • Haryana
    • Himachal Pradesh
    • Jammu & Kashmir
    • Jharkhand
    • Karnataka
    • Kerala
    • Ladakh
    • Lakshadweep
    • Madhya Pradesh
    • Maharashtra
    • Manipur
    • Meghalaya
    • Mizoram
    • Nagaland
    • Odisha
    • Puducherry
    • Punjab
    • Rajasthan
    • Sikkim
    • Tamil Nadu
    • Telangana
    • Tripura
    • Uttar Pradesh
    • Uttrakhand
    • West Bengal
  • Medical Education
    • Ayush Education News
    • Dentistry Education News
    • Medical Admission News
    • Medical Colleges News
    • Medical Courses News
    • Medical Universities News
    • Nursing education News
    • Paramedical Education News
    • Study Abroad
  • Industry
    • Health Investment News
    • Health Startup News
    • Medical Devices News
    • Pharma News
      • CDSCO (Central Drugs Standard Control Organisation) News
    • Pharmacy Education News
    • Industry Perspective
  • Home
  • Neurology and Neurosurgery
  • Neurology & Neurosurgery News
  • Moderate systolic BP...

Moderate systolic BP lowering after endovascular therapy not safe in ischemic stroke patients

Written By : Dr. Kamal Kant Kohli Published On 29 Sept 2023 2:30 PM  |  Updated On 29 Sept 2023 2:30 PM
Moderate systolic BP lowering after    endovascular therapy not safe in ischemic stroke patients
  • facebook
  • twitter
  • linkedin
  • whatsapp
  • Telegram
  • Email

USA: Lower systolic blood pressure (SBP) targets less than either 140 mm Hg or 160 mm Hg after successful endovascular therapy may not be safe or effective among patients with acute ischemic stroke, a recent study published in JAMA has revealed.

"Using blood pressure medications to lower the top number of blood pressure readings (systolic blood pressure) may not be safe or effective among people who have an acute ischemic stroke and undergo successful mechanical clot removal," the University of Cincinnati and UC Health’s Eva Mistry, MBBS, national principal investigator and lead author of the BEST-II trial, reported these findings.

The study focused on patients who had undergone endovascular thrombectomy, a minimally invasive procedure for acute ischemic stroke patients that uses a catheter to remove a blood clot from a blood vessel in the brain, which restores blood flow.

“Endovascular therapy has changed the landscape in acute stroke treatment,” said Mistry, assistant professor in the Department of Neurology and Rehabilitation Medicine at UC’s College of Medicine and a UC Health physician at the UC Gardner Neuroscience Institute. “Patients do drastically better when they receive endovascular treatment, compared to when they don’t. But, despite the enormous effectiveness of endovascular treatment, about 50% of patients remain disabled or die at 90 days, so we are on a quest to understand if there are additional strategies that may further improve outcomes in these patients.”

One of the main aspects of treating patients after a stroke is to monitor and control their blood pressure, Mistry said. Previous research has indicated that higher systolic blood pressure after endovascular treatment is associated with greater disability in people who have had an acute ischemic stroke.

Systolic blood pressure between 140 mm and 160 mm has been associated with better outcomes following the procedure. Normal blood pressure is considered as less than 120 mm systolic and less than 80 mm diastolic (bottom number in a blood pressure reading). However, whether using blood pressure medications to artificially lower systolic blood pressure to less than 180 mm is safe and effective has not been demonstrated following clot removal.

“There is always the concern if blood pressure is lowered too much in patients who are having an acute ischemic stroke that it could make the size of their stroke worse by reducing already compromised blood flow in that area,” Mistry explained.

Study results

Researchers led by Mistry enrolled 120 patients (with an average age of 70 years, 58% female) who had an acute ischemic stroke and successful endovascular treatment at one of three urban comprehensive stroke centers between January 2020 and March 2022.

Forty patients were randomly assigned to have their systolic blood pressure lowered to a target of less than or equal to 180 mm; 40 patients were to be lowered to a systolic blood pressure of less than 160 mm; and 40 patients were targeted to reach a systolic blood pressure of less than 140 mm.

Patients were treated with a blood pressure medication called nicardipine, administered intravenously, started within one hour after endovascular treatment and given for 24 hours if their systolic blood pressure was above the target they were assigned. Researchers wanted to assess whether lowering blood pressure may cause harm to brain tissue, which is particularly vulnerable during the 24 hours after a stroke, and to assess disability 90 days later.

The study found the average 36-hour size of strokes showed no conclusive evidence of harm. In the 90-day disability outcome, there was only a slight indication of harm.

“Although the study did not find significant evidence of an unequivocal harm of lower blood pressure targets in this population in terms of worsening size of stroke or increasing disability, the trends indicated that there may only be marginal benefit of lowering post-endovascular treatment blood pressure on patients’ long-term disability," Mistry said. "In fact, there was an indication that lowering the blood pressure after thrombectomy may worsen patients’ long-term disability.”

Mistry said the study indicates that in most cases, patients' blood pressure should be allowed to be auto-regulated after endovascular treatment. Individual patients may require the lowering of blood pressure due to specific conditions, but it should be customized and not used as a blanket practice, she said.

“There should be individual patient decision making, such as if there are other medical reasons to lowering the blood pressure or if there are signs of significant bleeding in the brain," Mistry said. “Health care professionals should be cautious when lowering blood pressure after endovascular treatment, as there are some signs that blood pressure that’s too low may be harmful,” Mistry said.

The study’s limitations include the small number of patients involved in the trial. Additionally, because the trial was conducted at three centres, the results may not apply to stroke patients treated elsewhere.

Reference:

Mistry EA, Hart KW, Davis LT, et al. Blood Pressure Management After Endovascular Therapy for Acute Ischemic Stroke: The BEST-II Randomized Clinical Trial. JAMA. 2023;330(9):821–831. doi:10.1001/jama.2023.14330.

JAMAblood pressuresystolic blood pressureacute ischemic strokeendovascular therapy
Source : JAMA
Dr. Kamal Kant Kohli
Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

Show Full Article
Next Story

Editorial

First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

First Indian Consensus on Managing Refractory Gastroesophageal Reflux Disease Recommends Vonoprazan

Re-visiting the Role of Pneumococcal Vaccination in Patients with Cardiovascular Diseases

Re-visiting the Role of Pneumococcal Vaccination in Patients with Cardiovascular Diseases

Prediabetes and the Mind: Unraveling Cognitive and Mental Health Risks

Prediabetes and the Mind: Unraveling Cognitive and Mental Health Risks

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer - Dr Aditya Murali

Real-World Case study: Darbepoetin Alfa for Chemotherapy-Induced Anemia in Metastatic Breast Cancer...

Aspirin in Primary Prevention- When to Consider?

Aspirin in Primary Prevention- When to Consider?

View All

Journal Club Today

Is Fitness Overrated? Study Questions the True Impact of Fitness on Early Death

Is Fitness Overrated? Study Questions the True Impact of Fitness on Early Death

View All

Health News Today

Health Bulletin 17/ May/ 2025

Health Bulletin 17/ May/ 2025

View All
© 2022 All Rights Reserved.
Powered By: Hocalwire
X
We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok