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Intensive versus guideline‐recommended blood pressure reduction in acute lacunar stroke with intravenous thrombolysis therapy: The ENCHANTED trial
Author(s) -
Zhou Zien,
Xia Chao,
Carcel Cheryl,
Yoshimura Sohei,
Wang Xia,
Delcourt Candice,
Malavera Alejandra,
Chen Xiaoying,
Mair Grant,
Woodward Mark,
Chalmers John,
Demchuk Andrew M.,
Lindley Richard I.,
Robinson Thompson G.,
Parsons Mark W.,
Wardlaw Joanna M.,
Anderson Craig S.
Publication year - 2021
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14598
Subject(s) - medicine , lacunar stroke , thrombolysis , modified rankin scale , guideline , logistic regression , blood pressure , stroke (engine) , leukoaraiosis , randomization , randomized controlled trial , cardiology , physical therapy , ischemic stroke , disease , pathology , ischemia , mechanical engineering , dementia , myocardial infarction , engineering
Background and purpose This was an investigation of the differential effects of early intensive versus guideline‐recommended blood pressure (BP) lowering between lacunar and non‐lacunar acute ischaemic stroke (AIS) in the BP arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). Methods In 1,632 participants classified as having definite or probable lacunar ( n = 454 [27.8%]) or non‐lacunar AIS according to pre‐specified definitions based upon clinical and adjudicated imaging findings, mean BP changes over days 0–7 were plotted, and systolic BP differences by treatment between subgroups were estimated in generalized linear models. Logistic regression models were used to estimate the BP treatment effects on 90‐day outcomes (primary, an ordinal shift of modified Rankin scale scores) across lacunar and non‐lacunar AIS after adjustment for baseline covariables. Results Most baseline characteristics, acute BP and other management differed between lacunar and non‐lacunar AIS, but mean systolic BP differences by treatment were comparable at each time point (all p interaction > 0.12) and over 24 h post‐randomization (−5.5, 95% CI −6.5, −4.4 mmHg in lacunar AIS vs. −5.6, 95% CI −6.3, −4.8 mmHg in non‐lacunar AIS, p interaction = 0.93). The neutral effect of intensive BP lowering on functional outcome and the beneficial effect on intracranial haemorrhage were similar for the two subgroups (all p interaction > 0.19). Conclusions There were no differences in the treatment effect of early intensive versus guideline‐recommended BP lowering across lacunar and non‐lacunar AIS.