Intensive lowering of high BP reduces bleeding risk during stroke thrombolysis: Lancet

According to late-breaking science presented at the American Stroke Association's International Stroke Conference 2019, Intensive lowering of high BP reduces bleeding risk during stroke thrombolysis but did not improve post-stroke recovery.

The researchers investigated whether intensive lowering of systolic blood pressure to less than 140 millimetres of mercury (mm Hg) could lessen post-stroke disability and could safely reduce the risk of bleeding in the brain better than lowering systolic blood pressure to the standard recommended a target of less than 180 mm Hg over three days.

More than 2,000 patients (average age 67, 38 per cent women) from 110 hospitals in 15 countries were treated between 2013 and 2018.

Researchers found:

• 
  
  * The level of disability at 90 days did not differ between patients receiving intensive or standard blood pressure management.
  
  


• 
  
  * Significantly fewer patients had bleeding within the brain after intensive compared to standard blood pressure management.
  
  


• 
  
  * Large and serious bleeding in the brain were lower with intensive blood pressure lowering.
  
  


• 
  
  * No harm was identified for intensive blood pressure management.
  
  

The researchers said the results were influenced by the difference in blood pressure management between the patient groups being less than planned, with many patients in the standard treatment group receiving more blood pressure management lowering than typically used in clinical practice.

"This study clearly shows intensive blood pressure lowering has the potential to make thrombolysis treatment safer, by reducing the risk of serious bleeding in the brain," Anderson said.

More research is required to better understand why the reduced risk of bleeding in the brain did not translate into improved overall outcome for patients.

"These findings also highlight the need for more research to better understand the underlying mechanisms of benefit and harm of early intensive blood pressure lowering in the patients receiving modern reperfusion therapy with thrombolysis and devices, given that the reduction in brain haemorrhage failed to translate into improvements in overall recovery for patients," added Professor Tom Robinson, co-lead investigator and head of the Cardiovascular Research Centre at the University of Leicester, United Kingdom.

The large international clinical trial, Enhanced Control of Hypertension and Thrombolysis Stroke (ENCHANTED) study will be simultaneously published in The Lancet.