Intensive Blood Pressure lowering after thrombolysing Ischaemic Stroke Patients

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Intensive blood pressure lowering in patients treated with alteplase for acute ischaemic stroke did not lead to a significant improvement in outcome compared with guideline based blood pressure lowering. In the ENCHANTED study, presented by Craig Anderson (George Institute for Global Health, Sydney, Australia in the International stroke conference 2019) and Thompson Robinson (University of Leicester, UK), an open-label trial with blinded endpoint evaluation, 2196 patients with acute ischaemic stroke were randomised to receive intensive blood pressure lowering (n=1081, target 130–140 mm Hg within 1 h) or guideline-based blood pressure lowering (n=1115, target <180mmhg).

The treatment led to a modest 5 mm Hg difference in blood pressure between the groups (144·3 mm Hg vs 149·8 mm Hg) and there was no difference between the groups in functional status at 90 days on the modified Rankin Scale. However, fewer patients in the intensive group (n=160 [14·8%]) than in the guideline group (n=209 [18·7%]) had any intracranial haemorrhage.

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