Pre-endovascular therapy change in blood pressure is associated with outcomes in patients with stroke

The American Heart Association/American Stroke Association guideline recommends maintaining blood pressure (BP) below 185/110 mm Hg in acute stroke patients prior to initiating any form of reperfusion therapy.1 However, the evidence supporting this recommendation is not strong for patients undergoing endovascular treatment (EVT). Higher BP at presentation in these patients is associated with worse outcomes and haemorrhagic complications.2 However, BP-lowering prior to EVT for avoidance of hyperperfusion as well as induced hypertension for penumbral sustenance have been proposed to improve patient outcomes.2 3 Prior to further testing of these strategies, whether changes in BP in either direction prior to EVT are associated with functional outcomes needs to be assessed. Because any changes in pre-EVT BP may affect ultimate functional outcome through an effect on cerebral perfusion, we aimed to determine the association of the change in pre-EVT mean arterial BP (MAP) with 90-day functional outcomes. We conducted a post-hoc analysis of the ‘Blood pressure after Endovascular Stroke Therapy (BEST)’ study, which prospectively enrolled consecutive adult patients treated with EVT for an anterior (Internal Carotid Artery/M1/M2) acute ischaemic stroke at 12 comprehensive stroke centres across the USA from November 2017 to May 2018.4 Study variables included change in MAP from admission to immediately pre-EVT. MAP was calculated using the following formula: (2×diastolic BP+systolic BP)/3. The primary outcome was dichotomous 90-day modified Rankin score …