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<p>Optimal systolic blood pressure (SBP) targets after endovascular therapy (EVT) for stroke in older adults (≥ 65&#xa0;years) remain undefined. This study assessed age-stratified associations between early post-EVT SBP (first 6&#xa0;h) and outcomes. Post hoc analysis of two trials. Patients were stratified by age (18–64 vs. ≥ 65&#xa0;years) and SBP (≤ 120, 120–140, &gt; 140&#xa0;mmHg). Primary outcome was 90-day functional status (modified Rankin Scale, mRS). Inverse probability treatment weighting (IPTW) and multivariable regression adjusted for confounders. Post-EVT SBP data were available for 267 young and 395 old patients. IPTW analysis revealed that sustained SBP below 120&#xa0;mmHg during the first 6&#xa0;h post-EVT significantly enhanced functional independence in elderly patients (common OR: 2.00; 95% CI: 1.18–3.39). Among young cohorts, maintenance of SBP ≤ 120&#xa0;mmHg (cOR, 2.89; 95% CI, 1.45–5.82) and 120–140&#xa0;mmHg (cOR, 3.18; 95% CI, 1.58–6.47) were associated with a better outcome. sICH incidence demonstrated no statistically significant association with systolic blood pressure (SBP) levels (<i>P</i> = 0.21; 95% CI: 0.93–1.35). During the initial 6-h window post-EVT, younger patients with SBP ≤ 140&#xa0;mmHg and elderly patients with SBP ≤ 120&#xa0;mmHg were associated with favorable outcome. These results suggest that stricter blood pressure control may be particularly beneficial for older adults in the early post-EVT phase.</p><p><i>Trial Registration:</i> The DEVT registration: URL: <a href="http://www.chictr.org.cn">http://www.chictr.org.cn</a>; Chinese Clinical Trial Registry: ChiCTR-IOR-17013568, and the RESCUE BT registration: URL: <a href="http://www.chictr.org.cn">http://www.chictr.org.cn</a>; ChiCTR-INR-17014167.</p> Graphical Abstract <p></p>

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Blood pressure in the first 6 hours for older adults with stroke after endovascular therapy: a pooled analysis of the DEVT and RESCUE BT randomized clinical trials

  • 期刊论文

  • 发表日期：

    2025年9月4日

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  • Cheng Ma,
  • Jingfan Li,
  • Xinyue Zheng,
  • Dahong Yang,
  • Qiangqiang Zhang,
  • Chong Zhang,
  • Yunlong Wang,
  • Xiang Li,
  • Chen Hu,
  • Guannan Tong,
  • Ke Tao,
  • Jinrong Hu,
  • Jian Miao,
  • Wenzhe Wang

摘要

Optimal systolic blood pressure (SBP) targets after endovascular therapy (EVT) for stroke in older adults (≥ 65 years) remain undefined. This study assessed age-stratified associations between early post-EVT SBP (first 6 h) and outcomes. Post hoc analysis of two trials. Patients were stratified by age (18–64 vs. ≥ 65 years) and SBP (≤ 120, 120–140, > 140 mmHg). Primary outcome was 90-day functional status (modified Rankin Scale, mRS). Inverse probability treatment weighting (IPTW) and multivariable regression adjusted for confounders. Post-EVT SBP data were available for 267 young and 395 old patients. IPTW analysis revealed that sustained SBP below 120 mmHg during the first 6 h post-EVT significantly enhanced functional independence in elderly patients (common OR: 2.00; 95% CI: 1.18–3.39). Among young cohorts, maintenance of SBP ≤ 120 mmHg (cOR, 2.89; 95% CI, 1.45–5.82) and 120–140 mmHg (cOR, 3.18; 95% CI, 1.58–6.47) were associated with a better outcome. sICH incidence demonstrated no statistically significant association with systolic blood pressure (SBP) levels (P = 0.21; 95% CI: 0.93–1.35). During the initial 6-h window post-EVT, younger patients with SBP ≤ 140 mmHg and elderly patients with SBP ≤ 120 mmHg were associated with favorable outcome. These results suggest that stricter blood pressure control may be particularly beneficial for older adults in the early post-EVT phase.

Trial Registration: The DEVT registration: URL: http://www.chictr.org.cn; Chinese Clinical Trial Registry: ChiCTR-IOR-17013568, and the RESCUE BT registration: URL: http://www.chictr.org.cn; ChiCTR-INR-17014167.

Graphical Abstract