<div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="3" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{9}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">A reperfusion-guided systolic blood pressure strategy improves 90-day functional outcomes after successful endovascular therapy for acute ischemic stroke, new randomized trial data<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW203091378 BCX0">suggest</span><span class="NormalTextRun SCXW203091378 BCX0">.</span></span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="4" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{11}"><span class="NormalTextRun SCXW203091378 BCX0">The trial, published online in<span> </span></span><em><span class="NormalTextRun SCXW203091378 BCX0">JAMA Neurology</span></em><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">, found that more patients reached functional independence with the tailored strategy than with guideline-recommended care, and that hemorrhagic transformation occurred less often, without an increase in symptomatic hemorrhage,<span> </span></span><span class="NormalTextRun SCXW203091378 BCX0">death</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>or serious adverse events.</span></span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="1521956575" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{13}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">Led by Pol Camps-</span><span class="NormalTextRun SpellingErrorV2Themed SCXW203091378 BCX0">Renom</span><span class="NormalTextRun SCXW203091378 BCX0">, PhD, of Hospital de la Santa Creu i Sant Pau in Barcelona, Spain, the investigators noted that elevated blood pressure after thrombectomy is associated with worse outcomes, yet six prior randomized trials of intensive blood pressure lowering had shown no benefit or harm.<span> </span></span></span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" lang="EN-US" paraid="5" paraeid="{c2eedbb3-e14b-4761-a347-d71bb6671bd3}{163}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">Rather than<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW203091378 BCX0">apply</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>a single uniform target, HOPE<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW203091378 BCX0">set</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>the systolic pressure goal by the degree of reperfusion achieved, on the rationale that patients with incomplete reperfusion depend more on collateral circulation and may require higher pressures.</span></span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="6" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{15}"><span class="NormalTextRun SCXW203091378 BCX0">"The findings should be interpreted as hypothesis generating rather than practice changing," the authors wrote, citing the trial's early termination and the small proportion of patients with incomplete reperfusion.</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="7" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{17}"><strong><span class="NormalTextRun SCXW203091378 BCX0">Study details</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="8" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{19}"><span class="NormalTextRun SCXW203091378 BCX0">HOPE was an investigator-initiated, open-label trial with blinded outcome assessment at 11 stroke centers in Spain, the investigators reported. It enrolled 440 adults with anterior-circulation large-vessel stroke who had achieved successful reperfusion.</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="9" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{21}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">Patients were randomized to a reperfusion-guided systolic blood pressure target or to standard care holding systolic pressure at or below<span> </span></span><span class="NormalTextRun SCXW203091378 BCX0">180 mm</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>Hg for<span> </span></span><span class="NormalTextRun SCXW203091378 BCX0">72 hours</span><span class="NormalTextRun SCXW203091378 BCX0">, according to the researchers. In the intervention group, the target was set by the degree of reperfusion: 100 to<span> </span></span><span class="NormalTextRun SCXW203091378 BCX0">140 mm</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>Hg for near-complete or complete reperfusion (</span><span class="NormalTextRun SpellingErrorV2Themed SCXW203091378 BCX0">mTICI</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>2c or 3) and 140 to<span> </span></span><span class="NormalTextRun SCXW203091378 BCX0">160 mm</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>Hg for incomplete reperfusion (</span><span class="NormalTextRun SpellingErrorV2Themed SCXW203091378 BCX0">mTICI</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>2b), with antihypertensive agents or vasopressors used to reach the assigned range.</span></span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="10" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{23}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">The patients’ mean age was 75 years, 53% of patients were women and the median National Institutes of Health Stroke Scale score was 16, the team noted. Incomplete reperfusion was uncommon, present in 9.8% of the cohort, while 90.2% had<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW203091378 BCX0">near-complete</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>or complete reperfusion; 60.6% of strokes were cardioembolic.</span></span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="11" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{25}"><span class="NormalTextRun SCXW203091378 BCX0">At 90 days, 60.0% of the intervention group reached functional independence, a modified Rankin Scale score of 0 to 2, compared with 47.1% of the control group, the authors wrote, an absolute difference of 13.3% (95% confidence interval [CI]: 4.1%-22.6%; p = 0.005; odds ratio [OR]: 1.71; 95% CI: 1.17-2.50). The estimate was unchanged after adjustment for prognostic factors.</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="12" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{27}"><span class="NormalTextRun SCXW203091378 BCX0">A shift analysis across the disability range also favored the intervention (common OR: 1.43; 95% CI: 1.03-2.00), the investigators reported, and hemorrhagic transformation was less frequent, at 22.3% vs 31.6% (OR: 0.62; 95% CI: 0.41-0.95). Symptomatic intracranial hemorrhage (3.5% vs 3.9%), 90-day mortality (about 15% in each group) and serious adverse events (15.8% vs 12.0%) did not differ between groups, they added.</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="13" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{29}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">Among patients with near-complete or complete reperfusion, the intervention group achieved a mean systolic pressure<span> </span></span><span class="NormalTextRun SCXW203091378 BCX0">9 mm</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>Hg lower than the control group (p < 0.001), the researchers said. In the incomplete reperfusion group, the two arms did not differ significantly, and the subgroup analysis showed no clear benefit in those patients.</span></span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="14" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{31}"><strong><span class="NormalTextRun SCXW203091378 BCX0">Ready for practice?</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="15" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{33}"><span class="NormalTextRun SCXW203091378 BCX0">The authors attributed the contrast with earlier trials partly to differences in the patients. Far fewer had incomplete reperfusion than in the neutral BP-TARGET and BEST-II trials, large-artery atherosclerosis was uncommon, most strokes were cardioembolic and baseline blood pressure was lower, since patients did not have to be hypertensive to enroll. The benefit could not be attributed to the reperfusion-stratified targets alone, the team said, because those targets were not fully achieved in the incomplete-reperfusion group.</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="16" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{35}"><span class="NormalTextRun SCXW203091378 BCX0">The trial also stopped early for lack of funding, short of its enrollment target, the investigators acknowledged, and a baseline imbalance left more hypertension and slightly more severe strokes in the control group. They positioned HOPE as a basis for designing larger, adequately powered trials and as complementary to existing reperfusion strategies rather than a replacement for them.</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" paraid="395443600" paraeid="{64a1e18c-1dcc-49ad-9761-7558c7c8b7ef}{37}"><strong><span class="NormalTextRun SCXW203091378 BCX0">Source: </span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" lang="EN-US" paraid="17" paraeid="{abaa492c-0149-4f6f-a276-7a96dde45468}{99}"><span data-contrast="auto" xml:lang="EN-US" lang="EN-US" class="TextRun SCXW203091378 BCX0"><span class="NormalTextRun SCXW203091378 BCX0">Camps-</span><span class="NormalTextRun SpellingErrorV2Themed SCXW203091378 BCX0">Renom</span><span class="NormalTextRun SCXW203091378 BCX0"><span> </span>P, Guasch-Jiménez M, Álvarez-Cienfuegos J, et al. Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke: A Randomized Clinical Trial.<span> </span></span></span><em><span class="NormalTextRun SCXW203091378 BCX0">JAMA Neurol</span></em><span class="NormalTextRun SCXW203091378 BCX0">. 2026 June 8 (Article in Press).</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></p> </div> <div class="OutlineElement Ltr SCXW203091378 BCX0"> <p class="Paragraph SCXW203091378 BCX0" lang="EN-US" paraid="1553730835" paraeid="{abaa492c-0149-4f6f-a276-7a96dde45468}{197}"><strong><span class="NormalTextRun SCXW203091378 BCX0">Image Credit: MQ-Illustrations – stock.adobe.com</span><span class="EOP Selected SCXW203091378 BCX0" data-ccp-props="{"335559738":240,"335559739":240}"> </span></strong></p> </div>