ESOC 2023 | Association between blood pressure and outcomes after endovascular thrombectomy
Aristeidis Katsanos, MD, McMaster University, Hamilton, Ontario, Canada, shares recent findings from an individual patient data metanalysis, investigating mean systolic blood pressure after endovascular thrombectomy (EVT) in patients with acute ischemic stroke, and its association with functional outcomes. The group assessed the blood pressure trajectories over 24 hours and associated this with patient outcome, in nearly 3000 patients. Patients were grouped into three blood pressure categories low, middle, and high. Patients with a higher blood pressure displayed poorer outcomes, in comparison to patients with a low and medium blood pressure. There was no statistically significant difference in the mortality of patients with a high blood pressure. A separate analysis of the data assessed the variability of blood pressure in patients, and categorised patients as having low, medium, or high variability. This analysis determined patients with high variability had worse functional outcomes in comparison to patients with low and medium blood pressure. This interview took place during the European Stroke Organisation Conference (ESOC) in Munich, Germany.
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Transcript (edited for clarity)
So we published in Neurology, it was a year ago, an individual patient data meta-analysis when we looked at the association between the mean systolic blood pressure at 24 hours and patient outcomes. So for this analysis, what we did, we looked at the trajectories, the trajectories means the blood pressure scores over the 24 hours, and what was the association with patient outcomes. So we’re able to analyze data from almost 3000 participants and what we did find out is that first of all, there are distinct trajectories...
So we published in Neurology, it was a year ago, an individual patient data meta-analysis when we looked at the association between the mean systolic blood pressure at 24 hours and patient outcomes. So for this analysis, what we did, we looked at the trajectories, the trajectories means the blood pressure scores over the 24 hours, and what was the association with patient outcomes. So we’re able to analyze data from almost 3000 participants and what we did find out is that first of all, there are distinct trajectories. So there are patients that they stay in the low trajectory, that their blood pressure stays low through the course of the first 24 hours. There are patients that they stay somewhere in the middle, according to our calculation, somewhere between the 120-140, and there are the ones with persistently elevated blood pressure, which is above 150. And the last group is the minority of the patients. So in our in our analysis, it was less than 10% of the participants of the individual patient data meta-analysis.
So we did find out that the ones in the higher systolic blood pressure trajectories, they have worse outcomes. They have increased risk of intracranial bleeding and also worse functional outcome as assessed with the three-month mRS scores. For the disability, we find out that you know, the ones that they are lingering in the higher blood pressure trajectories, they have a higher likelihood of a worse functional outcomes. For mortality, we didn’t find any statistical significant difference, but of course this could be due to the limited power and maybe we’re not powered enough to show this change in mortality.
This was a separate analysis presented in one of the poster sessions. We analyzed the exact same data set, but at this time, except for looking at the trajectory, we looked at the variability. So the variability between the blood pressure measurements within an individual. And so again, what we did find out is that when you have increased blood pressure variability and what we did, we analyzed the data and we categorized the patients in three different groups, the ones that they have low variability, the ones that they have medium variability and the ones that they have higher variability. So the ones that they were having higher variability, they had again worse functional outcomes and a higher likelihood of morbidity at three months.
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