TY - JOUR
T1 - Effects of Intensive Blood Pressure Lowering on Brain Swelling in Thrombolyzed Acute Ischemic Stroke
T2 - The ENCHANTED Results
AU - For the ENCHANTED investigators
AU - Zhang, Guobin
AU - Chen, Chen
AU - Ren, Xinwen
AU - Zhao, Yang
AU - Ouyang, Menglu
AU - Billot, Laurent
AU - Li, Qiang
AU - Wang, Xia
AU - Zhang, Luyun
AU - Ong, Sheila
AU - Liu, Leibo
AU - You, Shoujiang
AU - Lindley, Richard I.
AU - Robinson, Thompson G.
AU - Li, Gang
AU - Chen, Xiaoying
AU - Sui, Yi
AU - Anderson, Craig S.
AU - Song, Lili
AU - Krause, M.
AU - Priglinger, M.
AU - Day, S.
AU - Jala, S.
AU - Davies, L.
AU - Delcourt, C.
AU - Carcel, C.
AU - Malavera, A.
AU - Ray, E.
AU - Anderson, C. S.
AU - Wijeratne, T.
AU - Celestino, S.
AU - Law, L. Y.
AU - Ng, G.
AU - Nagao, K.
AU - Weiss, G.
AU - Titton, N.
AU - Batista, C.
AU - Zãn, D.
AU - Carbonera, L.
AU - Ferreira, K.
AU - Castro, R.
AU - Martins Filho, R. K.
AU - Carvalho, M.
AU - Libardi, M.
AU - Martins, G.
AU - Fagundes, D.
AU - Baron, G.
AU - Boehringer, A.
AU - Barbosa, J.
AU - Huang, Y. C.
N1 - Publisher Copyright:
© 2025 American Heart Association, Inc.
PY - 2025/6/1
Y1 - 2025/6/1
N2 - BACKGROUND: Cerebral swelling in relation to cytotoxic edema is a predictor of poor outcome in acute ischemic stroke (AIS) and elevated blood pressure (BP) promotes its development. Whether intensive BP-lowering treatment reduces cerebral swelling is uncertain. We aimed to determine whether intensive BP lowering reduces the severity of cerebral swelling after thrombolysis for AIS.METHODS: A secondary analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial factorial, international, multicenter, open-label, blinded end point, randomized controlled trial of alteplase dose and levels of BP control in thrombolyzed patients with AIS. Participants were randomly assigned to intensive (systolic target 130-140 mm Hg within 1 hour; maintained for 72 hours) or guideline-recommended (systolic target <180 mm Hg) BP management. Available serial brain images (baseline and follow-up, computed tomography, or magnetic resonance imaging) were centrally analyzed with standardized techniques (Apollo MIStar software) by expert readers blind to clinical details to rate swelling severity (from 0 no to 6 most severe swelling [midline shift and effacement of basal cisterns]) and other abnormalities. Primary outcome was any cerebral swelling (score, 1-6) in logistic regression models.RESULTS: Of 1477/2196 (67.3%) patients (mean age, 67.7 years; female, 39.6%) with sequential scans, the between-group mean systolic BP difference was 6.6 mm Hg over 24 hours. No significant difference was found in the treatment effect on any cerebral swelling between intensive and guideline-recommended BP management (22.12% versus 22.39%, adjusted odds ratio, 1.05 [95% CI, 0.81-1.36];
P=0.71). Results were consistent across different groups of swelling severity (swelling score 2-6, 3-6, and 4-6; and ordinal shift on swelling score).
CONCLUSIONS: Modest early intensive BP lowering does not seem to alter cerebral swelling in thrombolyzed patients with AIS. Further research is needed to quantify brain edema to allow a better understanding of the complex relations of BP and outcomes from AIS.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01422616.
AB - BACKGROUND: Cerebral swelling in relation to cytotoxic edema is a predictor of poor outcome in acute ischemic stroke (AIS) and elevated blood pressure (BP) promotes its development. Whether intensive BP-lowering treatment reduces cerebral swelling is uncertain. We aimed to determine whether intensive BP lowering reduces the severity of cerebral swelling after thrombolysis for AIS.METHODS: A secondary analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial factorial, international, multicenter, open-label, blinded end point, randomized controlled trial of alteplase dose and levels of BP control in thrombolyzed patients with AIS. Participants were randomly assigned to intensive (systolic target 130-140 mm Hg within 1 hour; maintained for 72 hours) or guideline-recommended (systolic target <180 mm Hg) BP management. Available serial brain images (baseline and follow-up, computed tomography, or magnetic resonance imaging) were centrally analyzed with standardized techniques (Apollo MIStar software) by expert readers blind to clinical details to rate swelling severity (from 0 no to 6 most severe swelling [midline shift and effacement of basal cisterns]) and other abnormalities. Primary outcome was any cerebral swelling (score, 1-6) in logistic regression models.RESULTS: Of 1477/2196 (67.3%) patients (mean age, 67.7 years; female, 39.6%) with sequential scans, the between-group mean systolic BP difference was 6.6 mm Hg over 24 hours. No significant difference was found in the treatment effect on any cerebral swelling between intensive and guideline-recommended BP management (22.12% versus 22.39%, adjusted odds ratio, 1.05 [95% CI, 0.81-1.36];
P=0.71). Results were consistent across different groups of swelling severity (swelling score 2-6, 3-6, and 4-6; and ordinal shift on swelling score).
CONCLUSIONS: Modest early intensive BP lowering does not seem to alter cerebral swelling in thrombolyzed patients with AIS. Further research is needed to quantify brain edema to allow a better understanding of the complex relations of BP and outcomes from AIS.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01422616.
KW - blood pressure
KW - brain edema
KW - clinical trial
KW - ischemic stroke
KW - thrombolytic therapy
UR - https://www.scopus.com/pages/publications/105002618668
U2 - 10.1161/STROKEAHA.124.049938
DO - 10.1161/STROKEAHA.124.049938
M3 - 文章
C2 - 40177745
AN - SCOPUS:105002618668
SN - 0039-2499
VL - 56
SP - 1388
EP - 1395
JO - Stroke
JF - Stroke
IS - 6
ER -
