ABSTRACT NUMBER: ESOC2026A936 PRE-HOSPITAL BP MANAGEMENT IN THROMBOLYSIS ACUTE ISCHEMIC STROKE PATIENTS: INTERACT4 RESULTS

Abstract Background and aims Optimal BP management in AIS patients prior to intravenous thrombolysis (IVT) remains uncertain. We determined associations between key SBP control measures and functional outcome in IVT-AIS patients in INTERACT4. Methods INTERACT4 was a multicenter open blinded outcome–assessed randomized trial of intensive BP-lowering (target SBP 130–140 mmHg < 30 minutes) in the ambulance versus usual care at 51 hospitals in China. IVT(EVT)-AIS patients were assessed for associations of SBP measures—prehospital (ambulance) reduction magnitude and SBP at hospital arrival—and functional outcome (90-day mRS distribution) using logistic regression and cubic spline models, adjusted for treatment group, baseline SBP, FAST score, age, and sex. SBP trajectory analysis explored patient profiles prone to optimal outcome. Results Of 587 AIS patients (mean age 73 years; 43% female), a J-shaped association was observed for prehospital SBP reduction and functional outcome: optimal at ~ 20 mmHg and greater reductions associated with worse outcome (non-linear P = 0.028). Lower hospital arrival SBP was continuously associated with better functional outcome (adjusted OR 1.07 per 10 mmHg reduction; 95%CI 1.01-1.14; P = 0.011). Trajectory analysis showed patients without active BP intervention, who presented with a spontaneous prehospital ~ 20 mmHg reduction in SBP, had better functional outcome compared with intervention-related trajectories, even with latter achieving similar or lower SBP at hospital arrival (p for trend = 0.027). Conclusions A narrow, modest (~20 mmHg) SBP reduction is associated with favorable outcome prior to IVT for AIS, suggesting that allowing SBP to decrease spontaneously by a similar magnitude might be a reasonable option in these patients. Conflict of interest Xinwen Ren: nothing to disclose.