Effect of blood pressure variability in the randomized controlled BP TARGET trial.

Background The BPTARGET trial [Blood Pressure (BP) Target in Acute Ischemic Stroke to Reduce Hemorrhage after Endovascular therapy (EVT)] evaluated whether an intensive systolic BP (SBP) target resulted in reduced rates of intracranial hemorrhage (ICH) after successful EVT but did not assess the effect of BP variability (BPV) on functional outcomes and ICH occurrence. We sought to evaluate this question in the BPTARGET trial. Methods We performed a post-hoc analysis of the BPTARGET trial and included patients with at least 50% of BP recordings during the first 24-hours after EVT. BPV parameters were SBP and diastolic BP (DBP) coefficient of variation (CV), standard deviation (SD), maximum-minimum, successive variation (SV) and the time rate (TR). The primary outcome was favorable functional outcome (3-month modified Rankin scale between 0-2); the secondary outcome was the rate of ICH at 24h. Results We included 290 patients (mean number of BP measures: 30.4 [SD=8.0]). BPV parameters (SBPSD , SBPmax-min , SBPCV ) were higher in the intensive SBP target group. Only DBP BPV parameters were associated with worse functional outcomes in the unadjusted model (DBPSD , DBPmax-min , DBPCV , and DBPSV ), but not after adjustment. Higher SBPmax-min was associated with worse functional outcomes in TICI 2b (OR=0.62; 95%CI, 0.38-1.02), but not in patients with complete reperfusion (OR=1.27; 95%CI, 0.80-2.02; phet =0.037). None of the BPV parameters were associated with ICH, regardless of the randomization group or the reperfusion grade. Conclusions BPV was significantly higher in the intensive SBP target group but was not associated with functional outcome or ICH.