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Randomized Controlled Trial
. 2019 Apr;30(2):372-379.
doi: 10.1007/s12028-018-0642-5.

Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial

Luiz Antonio Nasi  1 , Sheila Cristina Ouriques Martins  2   3 , Miguel Gus  4 , Gustavo Weiss  2   3 , Andrea Garcia de Almeida  2   3 , Rosane Brondani  2   3 , Letícia Costa Rebello  2   3 , Angélica DalPizzol  2   3 , Flávio Danni Fuchs  4 , Maria Júlia Monteiro Valença  2   3 , Letícia F Wirth  2 , Gerson Nunes  2 , Craig S Anderson  5
Affiliations
Randomized Controlled Trial

Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial

Luiz Antonio Nasi et al. Neurocrit Care. 2019 Apr.

Abstract

Introduction: There is uncertainty over the optimal level of systolic blood pressure (SBP) in the setting of acute ischemic stroke (AIS). The aim of this study was to determine the efficacy of the early manipulation of SBP in non-thrombolised patients. The key hypothesis under investigation was that clinical outcomes vary across ranges of SBP in AIS.

Methods: 218 patients were randomized within 12 h of AIS to maintain the SBP during 24 h within three ranges: Group 1 140-160 mmHg, Group 2 161-180 mmHg or Group 3 181-200 mmHg. Vasoactive drugs and fluids were used to achieve these targets. Good outcome was defined as a modified Rankin score 0-2 at 90-days.

Results: The median SBP in the three groups in 24 h was: 153 mmHg, 163 mmHg, and 178 mmHg, respectively, P < 0.0001. Good clinical outcome did not differ among the different groups (51% vs 52% vs 39%, P = 0.27). Symptomatic intracranial hemorrhage (SICH) was more frequent in the higher SBP range (1% vs 2.7% vs 9.1%, P = 0.048) with similar mortality rates. No patient had acute neurological deterioration related to the SBP reduction in the first 24 h. In our logistic regression analysis, the odds of having good clinical outcome was higher in Group 2 (OR 2.83) after adjusting for important confounders. Regardless of the assigned group, the probability of good outcome was 47% in patients who were manipulated to increase the BP, 42% to decrease and 62% in non-manipulated (P = 0.1). Adverse effects were limited to Group 2 (4%) and Group 3 (7.6%) and were associated with the use of norepinephrine (P = 0.05).

Conclusions: Good outcome in 90 days was not significantly different among the 3 blood pressure ranges. After logistic regression analysis, the odds of having good outcome was greater in Group 2 (SBP 161-180 mmHg). SICH occurred more frequently in Group 3 (181-200 mmHg).

Keywords: Acute stroke; Blood pressure; Hypertension; Ischemic stroke; Stroke.

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