Clinical Question
What's the post-EVT blood pressure target?
Synthesises 4 trialsfour RCTs across the post-EVT BP target question. And one harm signal
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· 4
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)
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)
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