Clinical Question
How aggressive should BP control be?
Synthesises 7 trialsprehospital, IV alteplase coadministration, and post-EVT targets
What does the guideline say?
- §4.3· 2026
After successful endovascular thrombectomy of an anterior-circulation large vessel occlusion, intensive systolic blood pressure lowering to <140 mmHg for 72 hours is harmful (Class III: Harm, Level A).
Source: 2026 AHA/ASA Guideline — §4.3 (Blood pressure management in acute ischemic stroke)
The trials cited in the guideline's supportive text appear below.
Trials in this question· 7
RIGHT-22019
No benefitOR 1.25
Ultra-acute transdermal GTN for presumed stroke shows no benefit and a harm signal in ICH.
No benefitOR 1.25
ENCHANTED2019
NScOR 1.01 (0.87–1.17)
Intensive post-alteplase BP lowering reduced any-ICH but did not improve 90-day disability.
NScOR 1.01 (0.87–1.17)
BP-TARGET2021
NSaOR 0.96 (0.60–1.51)
Intensive post-EVT BP (SBP 100–129) did not reduce radiographic hemorrhage.
NSaOR 0.96 (0.60–1.51)
MR ASAP2022
No benefitOR 0.92
Prehospital transdermal GTN for undifferentiated stroke shows no functional benefit.
No benefitOR 0.92
BEST-II2023
Futility14–25% predicted success
Phase 2 futility: lower post-EVT BP targets unlikely to succeed in a future superiority trial.
Futility14–25% predicted success
OPTIMAL-BP2023
HarmaOR 0.56 (0.33–0.96)
STOPPED FOR HARM: SBP <140 after EVT cut independence 15 pp and raised malignant edema 8×.
HarmaOR 0.56 (0.33–0.96)
INTERACT42024
NeutralOR 1.00
Prehospital BP lowering in undifferentiated stroke helps hemorrhagic and hurts ischemic patients (net null).
NeutralOR 1.00
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