Effect of Baseline Antihypertensive ...
Type de document :
Article dans une revue scientifique: Article original
PMID :
URL permanente :
Titre :
Effect of Baseline Antihypertensive Treatments on Stroke Severity and Outcomes in the BP TARGET Trial.
Auteur(s) :
Maier, Benjamin [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Gory, Benjamin [Auteur]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
Lapergue, Bertrand [Auteur]
Hôpital Foch [Suresnes]
Sibon, Igor [Auteur]
Hôpital Haut-Lévêque [CHU Bordeaux]
Richard, Sebastien [Auteur]
Université de Lorraine [UL]
Kyheng, Maéva [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Labreuche, Julien [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Desilles, Jean-Philippe [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Blanc, Raphael [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Piotin, Michel [Auteur]
Fondation Ophtalmologique Adolphe de Rotschild
Mazighi, Mikael [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Halimi, Jean-Michel [Auteur]
Transplantation, Immunologie, Inflammation [Tours] [T2i]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Gory, Benjamin [Auteur]
Imagerie Adaptative Diagnostique et Interventionnelle [IADI]
Lapergue, Bertrand [Auteur]
Hôpital Foch [Suresnes]
Sibon, Igor [Auteur]
Hôpital Haut-Lévêque [CHU Bordeaux]
Richard, Sebastien [Auteur]
Université de Lorraine [UL]
Kyheng, Maéva [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Labreuche, Julien [Auteur]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Desilles, Jean-Philippe [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Blanc, Raphael [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Piotin, Michel [Auteur]
Fondation Ophtalmologique Adolphe de Rotschild
Mazighi, Mikael [Auteur]
Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Halimi, Jean-Michel [Auteur]
Transplantation, Immunologie, Inflammation [Tours] [T2i]
Titre de la revue :
Stroke
Nom court de la revue :
Stroke
Numéro :
53
Pagination :
1837–1846
Date de publication :
2022-03-26
ISSN :
1524-4628
Mot(s)-clé(s) en anglais :
blood pressure
hypertension
ischemic stroke
renin-angiotensin system
thrombectomy
hypertension
ischemic stroke
renin-angiotensin system
thrombectomy
Discipline(s) HAL :
Sciences du Vivant [q-bio]
Résumé en anglais : [en]
Background:
Acute ischemic stroke (AIS) patients with a history of hypertension experience worse outcomes, which may be explained by a deleterious impact of the renin-angiotensin system (RAS) overactivation. We sought ...
Lire la suite >Background: Acute ischemic stroke (AIS) patients with a history of hypertension experience worse outcomes, which may be explained by a deleterious impact of the renin-angiotensin system (RAS) overactivation. We sought to investigate whether prestroke antihypertensive treatments (AHT) influenced baseline stroke severity and neurological outcomes, in patients with AIS successfully treated by endovascular therapy. Methods: We performed a post hoc analysis of the BP TARGET trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy) and included hypertensive patients with available data regarding AHT at admission, categorized as RAS inhibitors (ACE [angiotensin-converting enzyme] inhibitors, ARBs [angiotensin 2 receptor blockers], and β-blockers) and non-RAS inhibitors (calcium channel blockers and diuretics). Associations of each AHT with National Institutes of Health Stroke Scale (NIHSS) score at baseline were investigated in linear mixed model adjusted for the number of treatments and center. Associations of each AHT with 24-hour NIHSS change, intracranial hemorrhage were performed using linear mixed model adjusted for baseline NIHSS, the number of treatments, center, age, and sex and adjusted for age, sex, diabetes, and current smoking for favorable outcome. All analyses were performed on cases-available data regarding the low number of missing data. Results: Overall, 203 patients with at least one AHT were included. Patients under non-RAS inhibitor treatments had a higher NIHSS score at baseline (adjusted mean difference=3.28 [95% CI, 1.33–5.22]; P=0.001). Conversely, patients under RAS inhibitor treatments had a lower baseline NIHSS score (adjusted mean difference=−2.81 [95% CI, −5.37 to −0.25]; P=0.031). Intracranial hemorrhage occurrence was significantly more frequent in patients under non-RAS inhibitor treatments (adjusted odds ratio of 2.48 [95% CI, 1.12–5.47]; P=0.025). Conversely, the use of RAS inhibitor treatments before AIS was not associated with higher odds of radiographic intracranial hemorrhage. Patients with non-RAS inhibitor treatments had less improvement of NIHSS at 24 hours compared with patients without (adjusted mean difference, 2.83 [95% CI, −0.16 to 5.81]; P=0.063). Baseline RAS inhibitor or noninhibitor treatments were not associated with favorable outcome. Conclusions: We showed an opposite effect of baseline AHT, based on their effect on the RAS. Patients treated with RAS inhibitor agents before AIS exhibited less severe AIS compared with patients under non-RAS inhibitor treatments, developed less intracranial hemorrhage at 24 hours and had a trend toward better NIHSS score at 24 hours.Lire moins >
Lire la suite >Background: Acute ischemic stroke (AIS) patients with a history of hypertension experience worse outcomes, which may be explained by a deleterious impact of the renin-angiotensin system (RAS) overactivation. We sought to investigate whether prestroke antihypertensive treatments (AHT) influenced baseline stroke severity and neurological outcomes, in patients with AIS successfully treated by endovascular therapy. Methods: We performed a post hoc analysis of the BP TARGET trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy) and included hypertensive patients with available data regarding AHT at admission, categorized as RAS inhibitors (ACE [angiotensin-converting enzyme] inhibitors, ARBs [angiotensin 2 receptor blockers], and β-blockers) and non-RAS inhibitors (calcium channel blockers and diuretics). Associations of each AHT with National Institutes of Health Stroke Scale (NIHSS) score at baseline were investigated in linear mixed model adjusted for the number of treatments and center. Associations of each AHT with 24-hour NIHSS change, intracranial hemorrhage were performed using linear mixed model adjusted for baseline NIHSS, the number of treatments, center, age, and sex and adjusted for age, sex, diabetes, and current smoking for favorable outcome. All analyses were performed on cases-available data regarding the low number of missing data. Results: Overall, 203 patients with at least one AHT were included. Patients under non-RAS inhibitor treatments had a higher NIHSS score at baseline (adjusted mean difference=3.28 [95% CI, 1.33–5.22]; P=0.001). Conversely, patients under RAS inhibitor treatments had a lower baseline NIHSS score (adjusted mean difference=−2.81 [95% CI, −5.37 to −0.25]; P=0.031). Intracranial hemorrhage occurrence was significantly more frequent in patients under non-RAS inhibitor treatments (adjusted odds ratio of 2.48 [95% CI, 1.12–5.47]; P=0.025). Conversely, the use of RAS inhibitor treatments before AIS was not associated with higher odds of radiographic intracranial hemorrhage. Patients with non-RAS inhibitor treatments had less improvement of NIHSS at 24 hours compared with patients without (adjusted mean difference, 2.83 [95% CI, −0.16 to 5.81]; P=0.063). Baseline RAS inhibitor or noninhibitor treatments were not associated with favorable outcome. Conclusions: We showed an opposite effect of baseline AHT, based on their effect on the RAS. Patients treated with RAS inhibitor agents before AIS exhibited less severe AIS compared with patients under non-RAS inhibitor treatments, developed less intracranial hemorrhage at 24 hours and had a trend toward better NIHSS score at 24 hours.Lire moins >
Langue :
Anglais
Audience :
Internationale
Vulgarisation :
Non
Établissement(s) :
Université de Lille
CHU Lille
CHU Lille
Date de dépôt :
2023-11-15T04:26:17Z
2024-04-22T08:51:23Z
2024-04-22T08:51:23Z