Association of intensive blood pressure lowering with health-related quality of life after endovascular thrombectomy: a post-hoc analysis of the ENCHANTED2/MT trial

Clinical Snapshot

Key Findings

• P Value: EQ-5D: P=0.017; EQ VAS: P=0.028

• Effect Size: EQ-5D index: 0.06 point difference; EQ VAS: 3.49 point difference favouring less intensive BP control

• Primary Outcome: EQ-5D index and EQ VAS scores at 90 days

• Nnt Or Sensitivity: Effect sizes below commonly accepted thresholds for clinical importance in quality of life measures

• Confidence Interval: EQ-5D: 95% CI 0.01-0.11; EQ VAS: 95% CI 0.38-6.60

Clinical Application

Readily applicable in Australian stroke centres with established EVT programs and BP monitoring protocols Supports current Australian stroke guidelines favouring less aggressive BP targets post-EVT. Relevant for TGA-approved antihypertensive agents and aligns with RACGP hypertension management principles in acute stroke settings Australian stroke patients undergoing endovascular thrombectomy with post-procedural hypertension

Abstract

BACKGROUND AND PURPOSE: Intensive blood pressure (BP) targets of less than 120 mm Hg have been shown to worsen functional outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke. However, their effects on self-reported health-related quality of life (HRQoL) remain uncertain. METHODS: This post-hoc exploratory analysis used data from ENCHANTED2/MT, an open-label, blinded-endpoint randomized trial conducted in 44 Chinese hospitals. Adults with elevated BP within 3 h after successful reperfusion were randomized to intensive (< 120 mmHg) or less intensive (140-180 mmHg) systolic BP targets. HRQoL at 90 days was assessed using the EQ-5D-3 L and EQ visual analogue scale (EQ VAS). Functional outcome was measured by the modified Rankin Scale (mRS). Treatment effects were estimated using adjusted regression models, and causal mediation analysis was performed to explore indirect and direct pathways. RESULTS: Of 816 randomized patients, EQ-5D data were available in 685. At 90 days, both EQ-5D index (0.66 vs. 0.72) and EQ VAS (73.01 vs. 76.84) were lower in the more intensive BP group. Adjusted mean differences favored the less intensive treatment group: 0.06 (95% CI, 0.01 ~ 0.11; P = 0.017) for EQ-5D index and 3.49 (95% CI, 0.38 ~ 6.60; P = 0.028) for EQ VAS. Mediation analysis showed that the association of intensive BP lowering with worse HRQoL was mainly indirect via worse mRS outcomes. CONCLUSIONS: Intensive BP lowering after EVT was associated with modestly worse HRQoL at 90 days. The observed differences were small in magnitude, particularly for EQ VAS relative to commonly reported thresholds for clinical importance. These findings are consistent with less intensive BP targets after EVT and highlight the importance of incorporating patient-reported outcomes in acute stroke trials. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number, NCT04140110 the Registration Date, 22/10/2019.

References

1. 1.Gu, R., Ge, M., Wang, Z., Huyan, M., Wang, L., Gao, Y., Zhang, X., Zhang, Y., Zhang, L., Li, Z., Xing, P., Hua, W., Shen, F., Liu, J., Shen, H., & Yang, P. (2026). Association of intensive blood pressure lowering with health-related quality of life after endovascular thrombectomy: a post-hoc analysis of the ENCHANTED2/MT trial. Quality of Life Research. https://doi.org/10.1161/STROKEAHA.115.010075