BP-TARGET AHT Substudy
(2022)Objective
Whether baseline antihypertensive treatments influence stroke severity and outcomes after successful thrombectomy in patients enrolled in the BP-TARGET trial.
Study Summary
• Non-RAS inhibitors were associated with increased ICH at 24 hours.
• No clear association was found between baseline antihypertensive regimen and 3-month functional outcome after adjustment.
Intervention
Post hoc analysis of hypertensive patients from the BP-TARGET trial. Patients were categorized based on their prestroke antihypertensive regimen: RAS inhibitors (ACEi, ARBs, β-blockers) vs. non-RAS inhibitors (CCB, diuretics). Stroke severity (baseline NIHSS), ICH at 24 hours, 24-hour NIHSS change, and 3-month functional outcome were compared between groups.
Study Design
Arms: Array
Outcome
• Lower baseline NIHSS with RAS inhibitors: adjusted mean difference −2.81 (95% CI, −5.37 to −0.25), p=0.031
• More ICH at 24h with non-RAS inhibitors: adjusted OR 2.48 (95% CI, 1.12–5.47), p=0.025
• RAS inhibitors not associated with increased ICH
• 24h NIHSS change favored RAS inhibitors (not statistically significant)
• No independent association with 3-month mRS after multivariate adjustment
Bottom Line
In 203 hypertensive patients from BP-TARGET with LVO AIS post-EVT, prestroke non-RAS inhibitors (CCBs, diuretics) were associated with higher baseline NIHSS (+3.28 points; P=0.001) and 2.5x increased ICH risk (adjusted OR 2.48; P=0.025). RAS inhibitors (ACEi, ARBs, beta-blockers) were associated with lower NIHSS (-2.81; P=0.031) and no increased ICH. CCB use was independently associated with worse 3-month outcome (adjusted OR 0.42; P=0.044).
Major Points
- Post hoc analysis of BP TARGET RCT cohort evaluating impact of prestroke antihypertensive class on outcomes.
- RAS inhibitors included ACE inhibitors, ARBs, and beta-blockers; non-RAS included calcium channel blockers and diuretics.
- RAS inhibitor use associated with lower baseline NIHSS (−2.39 points; 95% CI −4.12 to −0.66) and better early neurological improvement (ΔNIHSS +3.28, p=0.001).
- Non-RAS inhibitor use was independently associated with higher risk of any ICH (OR 3.06; 95% CI 1.47–6.35, p=0.003).
- Favorable 90-day mRS (0–2) not significantly different between groups after adjustment (non-RAS vs RAS OR 0.59; 95% CI 0.30–1.17, p=0.13).
Study Design
- Study Type
- Post hoc observational analysis of a randomized controlled trial cohort (BP TARGET)
- Randomization
- No
- Blinding
- Outcome adjudication was blinded; treatment group assignment was open-label in original BP TARGET RCT
- Sample Size
- 203
- Follow-up
- 90 days
- Centers
- 13
- Countries
- France
Primary Outcome
Definition: 90-day modified Rankin Scale score (ordinal shift)
| Control | Intervention | HR/OR | P-value |
|---|---|---|---|
| No significant difference | No significant difference | - (OR 0.59; 95% CI 0.30–1.17) | 0.13 |
Limitations & Criticisms
- Post hoc design limits causal inference
- Potential unmeasured confounding between antihypertensive groups
- Overlap in medication classes (some patients received both RAS and non-RAS drugs)
- Small sample size limits generalizability
Citation
Stroke. 2022;53:3150–3159. doi:10.1161/STROKEAHA.122.039349