Probably futile
The results suggest that studying this issue further is probably futile. “If lowering blood pressure improves outcomes, that improvement is fairly marginal, and there are trends that suggest that, in fact, it might be harmful,” Dr. Mistry said. Her researcher team “believes it would not be the wisest decision” to pursue this strategy any further in a phase 3 study, she said.
“We wanted to understand whether or not we should spend millions of dollars to do a thousand-patient or two thousand-patient trial, and the answer to that is probably not.”
And there are other therapeutics “we can test that might be more promising than this approach,” she added.
In the meantime, Dr. Mistry stressed that clinicians should be cautious about automatically lowering blood pressure in this patient population and that decisions to target lower levels should be done on an individual basis.
Timely and important
In a comment, Karen Furie, MD, MPH, chair of neurology, Brown University, Providence, R.I., said that the study is “timely and important,” given the uncertainty about management of blood pressure after opening the vessel again using endovascular treatment.
“We already knew that letting the blood pressure go very high after reperfusion was bad, and this study shows that lowering it may also pose a risk, and I think that’s an important message for the community.”
The results send a cautionary message to clinicians but do not provide definitive evidence, she added. “Perhaps in the future we will have a better understanding of what the optimal range is.”
Dr. Furie stressed that this was a small pilot study and conclusions are “guarded.”
“I think the authors didn’t want to overinterpret the results so they ended up concluding that because the final disability might have been worse in the patients who had their blood pressure significantly lowered, recommending that as an approach across the board is sort of discouraged.”
Instead, the authors indicated that there may be factors such as degree of recanalization, size of the infarct, or other patient-specific factors “that would dictate where you target blood pressures,” Dr. Furie said.
The study was funded by the National Institutes of Health/National Institute of Neurological Disorders and Stroke. Mistry receives funding from the Patient-Centered Outcomes Research Institute and compensation from the American Heart Association for editorial activities, and is a consultant for RapidAI. Dr. Furie has declared no relevant financial relationships.
A version of this article first appeared on Medscape.com.