Therapeutic-induced hypertension in patients with noncardioembolic acute stroke. (19th November 2019)

• Record Type: Journal Article
• Authors: Bang, Oh Young; Chung, Jong-Won; Kim, Soo-Kyoung; Kim, Suk Jae; Lee, Mi Ji; Hwang, Jaechun; Seo, Woo-Keun; Ha, Yeon Soo; Sung, Sang Min; Kim, Eung-Gyu; Sohn, Sung-Il; Han, Moon-Ku
• Is Part Of: Neurology. Volume 93:Number 21(2019)
• Publication Date: 2019-11-19
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000008520
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: To evaluate the safety and efficacy of induced hypertension in patients with acute ischemic stroke. Methods: In this multicenter randomized clinical trial, patients with acute noncardioembolic ischemic stroke within 24 hours of onset who were ineligible for revascularization therapy and those with progressive stroke during hospitalization were randomly assigned (1:1) to the control and intervention groups. In the intervention group, phenylephrine was administered intravenously to increase systolic blood pressure (SBP) up to 200 mm Hg. The primary efficacy endpoint was early neurologic improvement (reduction in NIH Stroke Scale [NIHSS] score of ≥2 points during the first 7 days). The secondary efficacy endpoint was a modified Rankin Scale score of 0 to 2 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage/edema, myocardial infarction, and death. Results: In the modified intention-to-treat analyses, 76 and 77 patients were included in the intervention and control groups, respectively. After adjustment for age and initial stroke severity, induced hypertension increased the occurrence of the primary (odds ratio 2.49, 95% confidence interval [CI] 1.25–4.96, p = 0.010) and secondary (odds ratio 2.97, 95% CI 1.32–6.68, p = 0.009) efficacy endpoints. Sixty-seven (88.2%) patients of the intervention group exhibited improvements in NIHSS scores of ≥2 points during induced hypertension (mean SBP 179·7 ± 19.1 mm Hg). Safety outcomes did not significantly differ between groups. Conclusion: Among patients with noncardioembolic stroke who were ineligible for revascularization therapy and those with progressive stroke, phenylephrine-induced hypertension was safe and resulted in early neurologic improvement and long-term functional independence. ClinicalTrials.gov identifier: NCT01600235. Classification of evidence: This study provides Class III evidence that for patients with acute ischemic stroke, therapeutic-induced hypertension increases the probability of early neurologic improvement.