BP-TARGET Trial: Intensive vs Standard Blood Pressure Control After Successful EVT
In patients with acute LVO stroke who achieved successful recanalization after EVT, does targeting systolic blood pressure 100-129 mm Hg reduce post-reperfusion hemorrhage compared with a standard target of 130-185 mm Hg in the first 24 hours?
Mazighi et al. (Lancet Neurol 2021) · doi:10.1016/S1474-4422(20)30483-X · 324 patients
Population
Included
- Age 18 or older
- Anterior circulation LVO stroke
- Successful EVT (mTICI 2b or better)
- SBP greater than 130 mm Hg within 1 hour of EVT
- Randomization within 1 hour of procedure end
- Pre-stroke mRS 0 to 2
- Adults aged 18 years or older
- Acute ischaemic stroke consecutive to a large-vessel occlusion of the anterior circulation (intracranial internal carotid artery or proximal middle cerebral artery [M1], or both)
- Successful reperfusion by endovascular therapy, defined as modified Thrombolysis in Cerebral Infarction 2b or 3
Excluded
- SBP below 130 mm Hg at eligibility
- Hemorrhagic complication occurring during EVT
- Severe comorbidity precluding 24-hour protocol participation
- Pre-stroke mRS greater than 2
Key exclusion criteria
- Haemorrhagic complications during endovascular therapy
- Spontaneous systolic blood pressure decrease to less than 130 mm Hg after reperfusion
- Severe or fatal comorbidities that would have rendered the procedure unlikely to benefit the individual (for example, malignant cancer with reduced life expectancy)
- Pre-existing stroke disability defined by a modified Rankin Scale score greater than 2
- Known pregnancy
- Absence of written consent from the patient or the family
- Absence of a social insurance scheme
Source: Mazighi et al., Lancet Neurol 2021;20:265–274 (BP-TARGET)· Retrieved 2026-06-09
Primary Outcome — Radiographic iPH at 24-36 hours
324 patients; SBP 100-129 mm Hg vs 130-185 mm Hg after successful EVT
Negligible absolute difference
Any Radiographic iPH at 24-36 hours
Study Arms
- Agent
- Intravenous nicardipine first-line (most commonly used in French stroke units); investigators free to choose any antihypertensive agent per local practice
- Dose
- Target systolic blood pressure 100 to 129 mm Hg
- Route
- Intravenous
- Frequency
- Titrated to target; vasopressor therapies to raise BP were not used per French and European practice
- Duration
- Target achieved within 1 h after randomisation and maintained for 24 h
- Co-interventions
- Managed in an acute stroke unit by dedicated vascular neurologists; intravenous alteplase before endovascular therapy in 54% of this arm; BP measured noninvasively every 15 min for the first 2 h, then every 30 min for 6 h, then hourly for the remaining 16 h.
Intensive arm, n=162 (158 in ITT). Mazighi Lancet Neurol 2021 p.267.
- Agent
- Intravenous nicardipine first-line; investigators free to choose any antihypertensive agent per local practice
- Dose
- Target systolic blood pressure 130 to 185 mm Hg
- Route
- Intravenous
- Frequency
- Spontaneous decrease below 130 mm Hg was accepted and not actively raised; vasopressors not used
- Duration
- Target achieved within 1 h after randomisation and maintained for 24 h
- Co-interventions
- Managed in an acute stroke unit by dedicated vascular neurologists; intravenous alteplase before endovascular therapy in 52% of this arm; same noninvasive BP-monitoring schedule.
Standard arm, n=162 (160 in ITT). Upper threshold chosen per French and European guidelines at the time. Mazighi Lancet Neurol 2021 p.267.
Trial Design
Type
- Multicenter open-label randomized controlled trial
- Successful large-vessel EVT required before randomization
- SBP target 100-129 mm Hg vs 130-185 mm Hg
- Target achieved within 1 hour and maintained for 24 hours
Timeline
Four academic stroke centers in France
N
324
Enrollment
324 patients at four French academic stroke centers. Open-label randomized controlled trial with blinded endpoint assessment. Intensive BP target (SBP 100-129 mm Hg) achieved within 1 hour and maintained for 24 hours. Published Lancet Neurol 2021.
ClinicalTrials.gov
NCT03160677Bedside Pearl
BP-TARGET answered a narrow question: intensive BP lowering after successful EVT does not reduce radiographic hemorrhage. Combined with OPTIMAL-BP confirming functional harm from SBP <140 mm Hg, the evidence base is consistent. Do not target SBP below 140 mm Hg after successful reperfusion.