TOPLINE:

Both low (≤ 150 mm Hg) and high (> 150 mm Hg) systolic blood pressure (SBP) at admission were associated with poor functional outcomes and a higher rate of 90-day mortality in patients who underwent endovascular thrombectomy (EVT). However, among patients who underwent EVT alone, SBP > 150 mm Hg at admission was not significantly associated with worse outcomes.

METHODOLOGY:

• Researchers conducted a multicentre cohort study to evaluate the association of SBP at admission with outcomes in patients who underwent EVT.
• They included 10,963 patients (mean age, 72.8 years; 49.8% men; mean SBP at admission, 152 mm Hg) who were treated at 16 EVT centres between 2013 and 2023 and were stratified as those with SBP ≤ 150 mm Hg (n = 5672) or > 150 mm Hg (n = 5291) at admission.
• SBP at admission was defined as the first measured SBP recorded on the patient's arrival at the emergency department.
• The primary outcome was functional outcome at 90 days, determined using the modified Rankin Scale (mRS), with scores of 0-2 indicating good functional outcome and scores of 3-6 indicating poor functional outcome.
• Secondary outcomes included 90-day mortality, the 24-hour National Institutes of Health Stroke Scale (NIHSS) score, and symptomatic intracranial haemorrhage.

TAKEAWAY:

• In the total cohort, for patients with SBP ≤ 150 mm Hg at admission, each 10-mm Hg decrease was associated with 7% higher odds of poor functional outcome, whereas for those with SBP > 150 mm Hg at admission, each 10-mm Hg increase was associated with 5% higher odds of poor functional outcome after adjusting for covariates (P < .05 for both).
• Patients with SBP ≤ 150 mm Hg at admission had 17% higher odds of 90-day mortality for every 10-mm Hg decrease; those with SBP > 150 mm Hg at admission had 4% higher odds of 90-day mortality for each 10-mm Hg increase (P < .05 for both).
• Among patients with SBP > 150 mm Hg at admission, each 10‑mm Hg increase was associated with worse neurologic outcomes (reflected by an increase of 0.28 points in the 24‑hour NIHSS score) and 4% higher odds of symptomatic intracranial haemorrhage (P < .05 for both).
• In patients who underwent EVT alone, SBP < 150 mm Hg at admission was significantly associated with increased odds of poor functional outcome and mortality, but SPB > 150 mm Hg at admission was not significantly associated with poor outcomes.

IN PRACTICE:

"This study adds to the growing body of evidence suggesting that elevated BP [blood pressure] before EVT is not necessarily associated with poor outcome after EVT. These data imply that the benefits of timely EVT should not be compromised by delays caused by BP treatment," experts wrote in an editorial accompanying the article.

SOURCE:

The study was led by Nabila Wali, Department of Neurology, Amsterdam University Medical Center, University of Amsterdam in Amsterdam, Netherlands. It was published online on January 14, 2026, in Neurology.

LIMITATIONS:

The availability of only a single blood pressure value at admission prevented the assessment of the effects of potential fluctuations in blood pressure during and after the EVT procedure. The study lacked patient-level data on active blood pressure-lowering strategies. Because only patients who underwent EVT were included, the researchers could not analyse outcomes in patients who were denied EVT due to high blood pressure.

DISCLOSURES:

The authors declared that they received no targeted funding for this study. Several authors declared receiving funding, travel or speaker honoraria, and/or consulting or speaker fees from various pharmaceutical companies and other sources.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.