Intravenous antihypertensive administration before endovascular treatment in large vessel occlusion stroke: a pooled observational analysis of data from three randomized controlled trials.

OBJECTIVE: Whether patients suffering large vessel occlusion stroke with hypertension should be treated with intravenous antihypertensives (IV-antihypertensives) prior to endovascular treatment (EVT) remains unclear. We aimed to investigate the association between preprocedural IV-antihypertensives administration and clinical outcomes among this population. METHODS: This post hoc pooled observational analysis used data from three randomized controlled trials that investigated interventions other than preprocedural IV-antihypertensive treatment in patients with LVO stroke. Patients were stratified into two groups according to whether they received IV-antihypertensives prior to EVT or not. The primary effectiveness outcome was the distribution of the modified Rankin Scale (mRS) score across the full range at 90 days. Safety outcomes included 90-day mortality, and the incidence of 48-h symptomatic intracranial hemorrhage. RESULTS: A total of 1548 eligible patients were included in the study (non-IV-antihypertensives group, n = 1392; IV-antihypertensives group, n = 156). IV-antihypertensive group was with an unfavorable shift toward higher mRS score at 90 days compared with non-IV-antihypertensive group (adjusted odds ratio 0.70; 95% confidence interval, 0.51-0.96; P = 0.026). In the IV-antihypertensives group, there was a lower rate of successful reperfusion (P < 0.001), and a higher 90-day mortality (P < 0.001). Furthermore, relatively mild baseline stroke severity, smaller infarct core and shorter time of receiving EVT had worse functional outcomes in IV-antihypertensive group (P for interaction >0.05). CONCLUSION: IV-antihypertensives administration before EVT was associated with poorer 90-day functional outcomes, lower rates of successful reperfusion, and higher 90-day mortality in patients with LVO stroke. Nevertheless, these findings do not establish causality and warrant further confirmation.