Tailored blood pressure improved stroke recovery

Reopening-guided blood pressure targets improved 90-day independence after stroke clot removal.
*Randomized clinical trial; Level 2 (OCEBM).

Citation

Camps-Renom P, Guasch-Jiménez M, Álvarez-Cienfuegos J, et al. Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurology. 2026;83(8):788-797. doi:10.1001/jamaneurol.2026.1706

Background

After successful clot removal for severe ischemic stroke, the safest blood pressure target is uncertain. Prior trials of uniformly intensive blood pressure lowering showed no benefit or possible harm, so this study tested a more individualized approach.

Patients

440 previously independent adults in Spain with anterior-circulation large-vessel ischemic stroke and successful vessel reopening after endovascular therapy. Key exclusions included posterior-circulation stroke, large early brain injury, heart failure, arterial dissection, or untreated vessel narrowing of 50% or more.

Intervention

For 72 hours, systolic blood pressure target depended on reopening quality: 140-160 mm Hg for partial reopening; 100-140 mm Hg for near-complete or complete reopening.

Control

Guideline-recommended systolic blood pressure less than 180 mm Hg.

Outcome

Primary outcome: functional independence at 90 days, defined by modified Rankin Scale score 0-2 (0=no symptoms; 6=death).

Follow-up Period

90 days.

Results

Outcome Intervention Control Effect
Functional independence at 90 days (primary) 60.0% 47.1% OR 1.71 (95% CI 1.17 to 2.50); NNT 8
Better overall disability score distribution Favored intervention — OR 1.43 (95% CI 1.03 to 2.00)
Bleeding into damaged brain tissue at 24 hours 22.3% 31.6% OR 0.62 (95% CI 0.41 to 0.95); NNT 11 to prevent one event

Results were intention-to-treat. Symptomatic brain bleeding, early neurological worsening, serious adverse events, and 90-day mortality were not significantly different. The control reflected then-current guideline care.

Limitations

The trial stopped early because funding ended, reducing precision. Few patients had only partial vessel reopening, limiting conclusions for that subgroup. Patients with major untreated vessel narrowing were excluded, so results may not apply to higher-risk patients with poor blood flow reserve. Clinicians and patients were not blinded, although outcome assessors were.

Funding

Spanish public and European funds; funders had no study role.

Clinical Application

Consider individualized post-thrombectomy blood pressure targets in stroke centers, but await confirmation before replacing guideline-based practice broadly.