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Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial

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dc.contributor.authorChen, Chen
dc.contributor.authorOuyang, Menglu
dc.contributor.authorOng, Sheila
dc.contributor.authorZhang, Luyun
dc.contributor.authorZhang, Guobin
dc.contributor.authorDelcourt, Candice
dc.contributor.authorMair, Grant
dc.contributor.authorLiu, Leibo
dc.contributor.authorBillot, Laurent
dc.contributor.authorLi, Qiang
dc.contributor.authorChen, Xiaoying
dc.contributor.authorParsons, Mark
dc.contributor.authorBroderick, Joseph
dc.contributor.authorDemchuk, Andrew
dc.contributor.authorBath, Philip
dc.contributor.authorDonnan, Geoffrey
dc.contributor.authorLevi, Christopher
dc.contributor.authorChalmers, John
dc.contributor.authorLindley, Richard
dc.contributor.authorMartins, Sheila
dc.contributor.authorPontes-Neto, Octavio
dc.contributor.authorMunoz Venturelli, Paula
dc.contributor.authorOlavarría, Verónica V.
dc.contributor.authorLavados, Pablo
dc.contributor.authorRobinson, Thompson
dc.contributor.authorWardlaw, Joanna
dc.contributor.authorLi, Gang
dc.contributor.authorWang, Xia
dc.contributor.authorSong, Lili
dc.contributor.authorAnderson, Craig
dc.date.accessioned2024-04-03T13:38:01Z
dc.date.available2024-04-03T13:38:01Z
dc.date.issued2023
dc.description.abstractBackground: Intensive blood pressure lowering may adversely affect evolving cerebral ischaemia. We aimed to determine whether intensive blood pressure lowering altered the size of cerebral infarction in the 2196 patients who participated in the Enhanced Control of Hypertension and Thrombolysis Stroke Study, an international randomised controlled trial of intensive (systolic target 130-140 mm Hg within 1 h; maintained for 72 h) or guideline-recommended (systolic target <180 mm Hg) blood pressure management in patients with hypertension (systolic blood pressure >150 mm Hg) after thrombolysis treatment for acute ischaemic stroke between March 3, 2012 and April 30, 2018. Methods: All available brain imaging were analysed centrally by expert readers. Log-linear regression was used to determine the effects of intensive blood pressure lowering on the size of cerebral infarction, with adjustment for potential confounders. The primary analysis pertained to follow-up computerised tomography (CT) scans done between 24 and 36 h. Sensitivity analysis were undertaken in patients with only a follow-up magnetic resonance imaging (MRI) and either MRI or CT at 24-36 h, and in patients with any brain imaging done at any time during follow-up. This trial is registered with ClinicalTrials.gov, number NCT01422616. Findings: There were 1477 (67.3%) patients (mean age 67.7 [12.1] y; male 60%, Asian 65%) with available follow-up brain imaging for analysis, including 635 patients with a CT done at 24-36 h. Mean achieved systolic blood pressures over 1-24 h were 141 mm Hg and 149 mm Hg in the intensive group and guideline group, respectively. There was no effect of intensive blood pressure lowering on the median size (ml) of cerebral infarction on follow-up CT at 24-36 h (0.3 [IQR 0.0-16.6] in the intensive group and 0.9 [0.0-12.5] in the guideline group; log Δmean -0.17, 95% CI -0.78 to 0.43). The results were consistent in sensitivity and subgroup analyses. Interpretation: Intensive blood pressure lowering treatment to a systolic target <140 mm Hg within several hours after the onset of symptoms may not increase the size of cerebral infarction in patients who receive thrombolysis treatment for acute ischaemic stroke of mild to moderate neurological severity. Funding: National Health and Medical Research Council of Australia; UK Stroke Association; UK Dementia Research Institute; Ministry of Health and the National Council for Scientific and Technological Development of Brazil; Ministry for Health, Welfare, and Family Affairs of South Korea; Takeda.
dc.description.versionPublicada
dc.identifier.citationChen C, Ouyang M, Ong S, Zhang L, Zhang G, Delcourt C, Mair G, Liu L, Billot L, Li Q, Chen X, Parsons M, Broderick JP, Demchuk AM, Bath PM, Donnan GA, Levi C, Chalmers J, Lindley RI, Martins SO, Pontes-Neto OM, Venturelli PM, Olavarría V, Lavados P, Robinson TG, Wardlaw JM, Li G, Wang X, Song L, Anderson CS. Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial. EClinicalMedicine. 2023 Feb 15;57:101849. doi: 10.1016/j.eclinm.2023.101849
dc.identifier.doihttps://doi.org/10.1016/j.eclinm.2023.101849
dc.identifier.urihttps://hdl.handle.net/11447/8587
dc.language.isoen
dc.subjectBlood pressure
dc.subjectAcute ischaemic stroke
dc.subjectClinical trial
dc.subjectBrain imaging
dc.subjectCerebral infarction
dc.subjectThrombolysis
dc.titleEffects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceEClinicalMedicine
dspace.entity.typePublication
relation.isAuthorOfPublication77bec604-0a16-4d85-aaee-734c326e253a
relation.isAuthorOfPublicationdfb79a3c-f14a-4e52-b89e-0579bb6e7fda
relation.isAuthorOfPublicationce883977-0c50-41ce-a8ce-8adb22c2d09b
relation.isAuthorOfPublication.latestForDiscovery77bec604-0a16-4d85-aaee-734c326e253a

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