Association Between Intravenous Antihypertensives and Functional Outcome After Successful Endovascular Thrombectomy

Jae Wook Jung¹, Young Dae Kim¹, JoonNyung Heo¹, Hyungwoo Lee¹, Byung Moon Kim², Dong Joon Kim², Na-Young Shin², Haram Joo², Bang-Hoon Cho³, Seong Hwan Ahn⁴, Hyungjong Park⁵, Sung-Il Sohn⁵, Jeong-Ho Hong⁵, Jaeseob Yun⁵, Tae-Jin Song⁶, Yoonkyung Chang⁷, Gyu Sik Kim⁸, Kwon-Duk Seo⁸, Kijeong Lee⁸, Jun Young Chang⁹, Jung Hwa Seo¹⁰, Sukyoon Lee¹¹, Jang-Hyun Baek¹², Han-Jin Cho¹³, Dong Hoon Shin¹⁴, Jinkwon Kim¹⁵, Joonsang Yoo¹⁵, Minyoul Baik¹⁵, Yo Han Jung¹⁶, Yang-Ha Hwang¹⁷, Chi Kyung Kim¹⁸, Jae Guk Kim¹⁹, Il Hyung Lee²⁰, Jin Kyo Choi²¹, Chan Joo Lee²², Sungha Park^{22

23}, Soyoung Jeon²⁴, Hye Sun Lee²⁴, Kwang Hyun Kim²⁵, Sun U Kwon⁹, Oh Young Bang²⁶, Ji Hoe Heo¹, Hyo Suk Nam¹; OPTIMAL-BP Trial Investigators

Affiliations

¹ Department of Neurology (J.W.J., Y.D.K., J.H., H.L., J.H.H., H.S.N.), Yonsei University College of Medicine, Seoul, South Korea.
² Department of Radiology (B.M.K., D.J.K., N.-Y.S., H.J.), Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Neurology, South Korea University Anam Hospital and College of Medicine, Seoul (B.-H.C.).
⁴ Department of Neurology, Chosun University School of Medicine, Gwangju, South Korea (S.H.A.).
⁵ Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea (H.P., S.-I.S., J.-H.H., J. Yun).
⁶ Department of Neurology, Seoul Hospital (T.-J.S.), Ewha Woman's University, College of Medicine, South Korea.
⁷ Department of Neurology, Mokdong Hospital (Y.C.), Ewha Woman's University, College of Medicine, South Korea.
⁸ Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea (G.S.K., K.-D.S., K.L.).
⁹ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.Y.C., S.U.K.).
¹⁰ Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea (J.H.S.).
¹¹ Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, South Korea (S.L.).
¹² Department of Neurology, Kangbuk Samsung Hospital (J.-H.B.), Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹³ Department of Neurology, Pusan National University School of Medicine, Busan, South Korea (H.-J.C.).
¹⁴ Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea (D.H.S.).
¹⁵ Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, South Korea (J.K., J. Yoo, M.B.).
¹⁶ Department of Neurology, Gangnam Severance Hospital (Y.H.J.), Yonsei University College of Medicine, Seoul, South Korea.
¹⁷ Department of Neurology, Kyungpook National University Hospital (Y.-H.H.), School of Medicine, Kyungpook National University, Daegu, South Korea.
¹⁸ Department of Neurology, Korea University Guro Hospital and College of Medicine, Seoul, South Korea (C.K.K.).
¹⁹ Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, South Korea (J.G.K.).
²⁰ Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea (I.H.L.).
²¹ Department of Neurology, Seoul Medical Center, South Korea (J.K.C.).
²² Department of Health Promotion, Severance Hospital (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, South Korea.
²³ Cardiovascular Research Institute (S.P.), Yonsei University College of Medicine, Seoul, South Korea.
²⁴ Department of Research Affairs, Biostatistics Collaboration Unit (S.J., H.S.L.), Yonsei University College of Medicine, Seoul, South Korea.
²⁵ Department of Neurology, Kyungpook National University Chilgok Hospital (K.H.K.), School of Medicine, Kyungpook National University, Daegu, South Korea.
²⁶ Department of Neurology, Samsung Medical Center (O.Y.B.), Sungkyunkwan University School of Medicine, Seoul, South Korea.

PMID: 40605757
DOI: 10.1161/STROKEAHA.125.051696

Free article

Clinical Trial

Association Between Intravenous Antihypertensives and Functional Outcome After Successful Endovascular Thrombectomy

Jae Wook Jung et al. Stroke. 2025 Sep.

Free article

. 2025 Sep;56(9):2503-2515.

doi: 10.1161/STROKEAHA.125.051696. Epub 2025 Jul 3.

Authors

Affiliations

¹ Department of Neurology (J.W.J., Y.D.K., J.H., H.L., J.H.H., H.S.N.), Yonsei University College of Medicine, Seoul, South Korea.
² Department of Radiology (B.M.K., D.J.K., N.-Y.S., H.J.), Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Neurology, South Korea University Anam Hospital and College of Medicine, Seoul (B.-H.C.).
⁴ Department of Neurology, Chosun University School of Medicine, Gwangju, South Korea (S.H.A.).
⁵ Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea (H.P., S.-I.S., J.-H.H., J. Yun).
⁶ Department of Neurology, Seoul Hospital (T.-J.S.), Ewha Woman's University, College of Medicine, South Korea.
⁷ Department of Neurology, Mokdong Hospital (Y.C.), Ewha Woman's University, College of Medicine, South Korea.
⁸ Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea (G.S.K., K.-D.S., K.L.).
⁹ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.Y.C., S.U.K.).
¹⁰ Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea (J.H.S.).
¹¹ Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, South Korea (S.L.).
¹² Department of Neurology, Kangbuk Samsung Hospital (J.-H.B.), Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹³ Department of Neurology, Pusan National University School of Medicine, Busan, South Korea (H.-J.C.).
¹⁴ Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea (D.H.S.).
¹⁵ Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, South Korea (J.K., J. Yoo, M.B.).
¹⁶ Department of Neurology, Gangnam Severance Hospital (Y.H.J.), Yonsei University College of Medicine, Seoul, South Korea.
¹⁷ Department of Neurology, Kyungpook National University Hospital (Y.-H.H.), School of Medicine, Kyungpook National University, Daegu, South Korea.
¹⁸ Department of Neurology, Korea University Guro Hospital and College of Medicine, Seoul, South Korea (C.K.K.).
¹⁹ Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, South Korea (J.G.K.).
²⁰ Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea (I.H.L.).
²¹ Department of Neurology, Seoul Medical Center, South Korea (J.K.C.).
²² Department of Health Promotion, Severance Hospital (C.J.L., S.P.), Yonsei University College of Medicine, Seoul, South Korea.
²³ Cardiovascular Research Institute (S.P.), Yonsei University College of Medicine, Seoul, South Korea.
²⁴ Department of Research Affairs, Biostatistics Collaboration Unit (S.J., H.S.L.), Yonsei University College of Medicine, Seoul, South Korea.
²⁵ Department of Neurology, Kyungpook National University Chilgok Hospital (K.H.K.), School of Medicine, Kyungpook National University, Daegu, South Korea.
²⁶ Department of Neurology, Samsung Medical Center (O.Y.B.), Sungkyunkwan University School of Medicine, Seoul, South Korea.

PMID: 40605757
DOI: 10.1161/STROKEAHA.125.051696

Abstract

Background: Intravenous antihypertensives are frequently used to control blood pressure after successful endovascular thrombectomy (EVT), yet studies investigating the relationship between intravenous antihypertensive use and functional outcomes after successful EVT remain limited.

Methods: We conducted an exploratory secondary analysis of the OPTIMAL-BP trial (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control), which compared intensive (systolic blood pressure <140 mm Hg) versus conventional blood pressure management (systolic blood pressure, 140-180 mm Hg) within the first 24 hours after successful recanalization across 19 stroke centers in South Korea between June 2020 and November 2022. Patients were classified according to the administration of intravenous antihypertensives within the initial 24 hours after enrollment. The primary efficacy outcome was functional independence (modified Rankin Scale score of 0-2) at 3 months.

Results: Of the 302 patients (median, 75 years; 180 [59.6%] men), 141 (46.7%) received intravenous antihypertensives within the first 24 hours after EVT. Among the 141 patients who received intravenous antihypertensives, 133 (94.3%) were treated with nicardipine, 10 (7.0%) received labetalol, and 2 (1.4%) were administered both drugs. Patients who received intravenous antihypertensives had significantly lower rates of functional independence at 3 months (adjusted odds ratio, 0.51 [95% CI, 0.27-0.95]; P=0.035) and excellent neurological recovery at 24 hours (adjusted odds ratio, 0.46 [95% CI, 0.22-0.94]; P=0.036), as well as higher stroke-related mortality rates (adjusted odds ratio, 4.21 [95% CI, 1.24-16.4]; P=0.027), compared with patients who did not receive intravenous antihypertensives. Symptomatic intracerebral hemorrhage was not significantly different between groups (adjusted odds ratio, 1.67 [95% CI, 0.68-4.19]; P=0.267).

Conclusions: The use of intravenous antihypertensives within the first 24 hours after successful EVT was associated with worse functional outcomes at 3 months. This finding highlights the need for a cautious assessment of the risks and benefits of administering intravenous antihypertensives immediately after EVT.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04205305.

Keywords: antihypertensive agents; blood pressure; cerebral hemorrhage; ischemic stroke; thrombectomy.

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Conflict of interest statement

Dr Park reports compensation from Daiichi Sankyo Company, Ltd, for consultant services; compensation from Skylabs for consultant services; compensation from Daewon for other services; compensation from Organon for other services; compensation from Celltrion, Inc, for consultant services; compensation from Celltrion, Inc, for other services; stock options in Mediwhale; compensation from Boryung for other services; compensation from Handok Pharmaceuticals for other services; compensation from Chong Kun Dang for other services; compensation from Daewoong Pharmaceutical Company for consultant services; compensation from Daewoong Pharmaceutical Company for other services; grants from Daiichi Sankyo Company, Ltd; compensation from Skylabs for other services; and compensation from Daiichi Sankyo Company, Ltd, for other services. The other authors report no conflicts.

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Association Between Intravenous Antihypertensives and Functional Outcome After Successful Endovascular Thrombectomy

Affiliations

Association Between Intravenous Antihypertensives and Functional Outcome After Successful Endovascular Thrombectomy

Authors

Affiliations

Abstract

Conflict of interest statement

Publication types

MeSH terms

Substances

Associated data

LinkOut - more resources

Full Text Sources

Medical