Intensive Versus Conventional Blood Pressure Lowering After Successful Endovascular Thrombectomy: OPTIMAL-BP 1-Year Outcomes

BACKGROUND: Intensive blood pressure (BP) lowering after successful reperfusion has resulted in short-term harm in acute ischemic stroke. However, it remains unclear whether these adverse effects persist over the long term. METHODS: The OPTIMAL-BP (Outcome in Patients Treated With Intra-Arterial Thrombectomy–Optimal Blood Pressure Control) was a phase 3, multicenter, prospective, open-label, blinded end point, randomized controlled trial with 19 centers throughout South Korea. Patients who underwent endovascular thrombectomy for acute ischemic stroke caused by large vessel occlusion, achieved successful reperfusion of the occluded artery, and exhibited elevated BP (systolic BP ≥140 mm Hg) on 2 measurements obtained 2 minutes apart within 2 hours after recanalization were randomly assigned to receive intensive BP management (systolic BP target <140 mm Hg) or conventional management (systolic BP target, 140–180 mm Hg) for 24 hours after enrollment. This study was a 1-year follow-up extension of the OPTIMAL-BP. The primary outcomes were a modified Rankin Scale score of 0 to 2 at 1 year, indicating functional independence and all-cause mortality within 1 year. Adjusted odds ratios were estimated using multivariable logistic regression models adjusting for age, sex, onset-to-randomization time, and baseline National Institutes of Health Stroke Scale. RESULTS: Among 306 randomized patients, 294 (96.1%) completed the 1-year follow-up. In the intention-to-treat analysis, functional independence at 1 year was numerically lower in the intensive BP management group than in the conventional group (40.5% versus 52.7%; adjusted odds ratios, 0.59 [95% CI, 0.34–1.00]; P =0.051). Consistent findings were observed in the per-protocol analysis (41.1% versus 54.7%; adjusted odds ratios, 0.56 [95% CI, 0.32–0.97]; P =0.040). One-year mortality and distribution of modified Rankin Scale changes from 3 months to 1 year did not differ between groups. CONCLUSIONS: Intensive BP lowering targeting a systolic BP of <140 mm Hg resulted in worse functional outcomes at 1 year compared with conventional BP management. These randomized data suggest that early postthrombectomy BP management has durable effects on recovery and support current recommendations against intensive BP lowering. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04205305.

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Stroke
Published
2026-05-29
DOI
https://doi.org/10.1161/strokeaha.126.055632
Primary Topic
Acute Ischemic Stroke Management
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article
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article

Intensive Versus Conventional Blood Pressure Lowering After Successful Endovascular Thrombectomy: OPTIMAL-BP 1-Year Outcomes

JoonNyung Heo, Jin Kyo Choi, Seong Hwan Ahn, Byung Moon Kim et al.
Stroke
Acute Ischemic Stroke Management
article

Intensive Versus Conventional Blood Pressure Lowering After Successful Endovascular Thrombectomy: OPTIMAL-BP 1-Year Outcomes

JoonNyung Heo, Jin Kyo Choi, Seong Hwan Ahn, Byung Moon Kim, Sungwook Yu, Jae Wook Jung, Jin Gu Lee, Taedong Ok, Sang Hee Ha, Kwon–Duk Seo, Sukyoon Lee, Minyoul Baik, Hyungwoo Lee, Yong Wook Kim, Jaeseob Yun, Hyungjong Park, Yo Han Jung, Ji Hoe Heo, Dong Hoon Shin, Jinkwon Kim, Jun Young Chang, Jang-Hyun Baek, Yoonkyung Chang, Jae Guk Kim, Jung Hwa Seo, Dong Joon Kim, Sun U Kwon, Il Hyung Lee, Yang-Ha Hwang, Joonsang Yoo, Jeong-Ho Hong, Sung-Il Sohn, Hyo Suk Nam, Chi Kyung Kim, Na-Young Shin, Tae-Jin Song, Gyu Sik Kim, Haram Joo, Soyoung Jeon, Hye Sun Lee, Kwang Hyun Kim, Oh Young Bang, Han-Jin Cho
article en

Abstract

BACKGROUND: Intensive blood pressure (BP) lowering after successful reperfusion has resulted in short-term harm in acute ischemic stroke. However, it remains unclear whether these adverse effects persist over the long term. METHODS: The OPTIMAL-BP (Outcome in Patients Treated With Intra-Arterial Thrombectomy–Optimal Blood Pressure Control) was a phase 3, multicenter, prospective, open-label, blinded end point, randomized controlled trial with 19 centers throughout South Korea. Patients who underwent endovascular thrombectomy for acute ischemic stroke caused by large vessel occlusion, achieved successful reperfusion of the occluded artery, and exhibited elevated BP (systolic BP ≥140 mm Hg) on 2 measurements obtained 2 minutes apart within 2 hours after recanalization were randomly assigned to receive intensive BP management (systolic BP target <140 mm Hg) or conventional management (systolic BP target, 140–180 mm Hg) for 24 hours after enrollment. This study was a 1-year follow-up extension of the OPTIMAL-BP. The primary outcomes were a modified Rankin Scale score of 0 to 2 at 1 year, indicating functional independence and all-cause mortality within 1 year. Adjusted odds ratios were estimated using multivariable logistic regression models adjusting for age, sex, onset-to-randomization time, and baseline National Institutes of Health Stroke Scale. RESULTS: Among 306 randomized patients, 294 (96.1%) completed the 1-year follow-up. In the intention-to-treat analysis, functional independence at 1 year was numerically lower in the intensive BP management group than in the conventional group (40.5% versus 52.7%; adjusted odds ratios, 0.59 [95% CI, 0.34–1.00]; P =0.051). Consistent findings were observed in the per-protocol analysis (41.1% versus 54.7%; adjusted odds ratios, 0.56 [95% CI, 0.32–0.97]; P =0.040). One-year mortality and distribution of modified Rankin Scale changes from 3 months to 1 year did not differ between groups. CONCLUSIONS: Intensive BP lowering targeting a systolic BP of <140 mm Hg resulted in worse functional outcomes at 1 year compared with conventional BP management. These randomized data suggest that early postthrombectomy BP management has durable effects on recovery and support current recommendations against intensive BP lowering. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04205305.

Stroke
Ewha Womans University (KR), Chosun University (KR), Yonsei University (KR), Eulji University (KR), Severance Hospital (KR), Korea University Medical Center (KR), Dong-A University Hospital (KR), Kyungpook National University Hospital (KR), Samsung Medical Center (KR), University of Ulsan (KR), Seoul Medical Center (KR), Gachon University Gil Medical Center (KR), Kangbuk Samsung Hospital (KR), Inje University Busan Paik Hospital (KR), CHA University Bundang Medical Center (KR), Gangnam Severance Hospital (KR), Kyung Hee University Hospital at Gangdong (KR), National Health Insurance Service (KR), Korea University (JP), Pusan National University (KR), Keimyung University (KR)
Good health and well-being
Openalex Percentile: Top 6%
Acute Ischemic Stroke Management
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