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BP-TARGET

Effect of Baseline Antihypertensive Treatments on Stroke Severity and Outcomes in the BP TARGET Trial

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Year of Publication: 2022

Authors: Maïer B, Gory B, Lapergue B, ..., Halimi JM

Journal: Stroke

Citation: Maïer B, et al. Stroke. 2022;53:1837–1846. DOI: 10.1161/STROKEAHA.121.037548

Link: https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.037548

PDF: https://www.ahajournals.org/doi/epub/10....EAHA.121.037548

Clinical Question

Does the class of prestroke antihypertensive treatment influence stroke severity and neurological outcomes in patients with anterior large vessel occlusion treated by endovascular therapy?

Bottom Line

Patients treated with RAS inhibitors before stroke had less severe strokes and lower rates of intracranial hemorrhage than those on non-RAS inhibitors.

        Major Points
        Post hoc analysis of 203 hypertensive patients from BP TARGET trial.
RAS inhibitors were associated with lower baseline NIHSS scores.
Non-RAS inhibitors (CCB, diuretics) were linked to higher NIHSS and more intracranial hemorrhage.
RAS inhibitors showed a trend toward better 24-hour NIHSS improvement.
No significant differences in 3-month functional outcomes after multivariate adjustment.

      

Design

Study Type: Post hoc analysis of a randomized, controlled trial

Randomization: 1

Blinding: Open-label with blinded outcome assessment

Enrollment Period: 2017

Follow-up Duration: 3 months

Centers: 4

Countries: France

Sample Size: 203

Analysis: Mixed linear and logistic regression models with multivariate adjustments

Inclusion Criteria

Adult patients ≥18 years
Acute ischemic stroke from anterior circulation LVO
Successful endovascular therapy (TICI 2b or 3)
Known history of hypertension and AHT use

Exclusion Criteria

Hemorrhagic complications during EVT
Systolic BP <130 mmHg after reperfusion
Prestroke disability (mRS >2)
Pregnancy
Severe/fatal comorbidities

Baseline Characteristics

Characteristic	Comorbidities	Qualifying Event
Hypertension	100
Diabetes	75.5
Hyperlipidemia	44.3
Prior Stroke	81.1
Smoker	89.3

Arms

Field	RAS Inhibitors	Control
Intervention	ACE inhibitors, ARBs, or β-blockers before stroke	CCBs or diuretics before stroke
Duration	Prestroke treatment	Prestroke treatment

Outcomes

Outcome	Type	Control	Intervention	HR / OR / RR	P-value
Baseline NIHSS score	Primary	17.80	15.81	1.99%	0.031
Intracranial hemorrhage	Secondary	47.5%	43.0%		0.025
NIHSS improvement at 24h	Secondary	-3.21	-4.73		0.063
Favorable outcome at 3 months (mRS 0–2)	Secondary	45.5%	47.0%		0.38
Intracranial Hemorrhage at 24h	Adverse	47.5%	43.0%		0.025

Subgroup Analysis

RAS inhibitors vs non-RAS: better baseline NIHSS and ICH profile for RAS group; no significant interaction with age or sex.

Criticisms

Post hoc observational analysis with potential confounding.
Moderate sample size limited statistical power.
AHT regimens often mixed, limiting direct comparisons.
BP control history prior to stroke not available.
Findings may not apply to AIS patients not treated with EVT.

Funding

French Health Ministry via Fondation A. de Rothschild

Based on: BP-TARGET (Stroke, 2022)