Sex Differences in Blood Pressure Dynamics and Outcomes After Endovascular Thrombectomy.
Renjun Gu, Xuan Zhu, Zhenlin Wang et al.
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In 30 seconds
This exploratory secondary analysis of the multicenter, open-label, blinded-end-point ENCHANTED2/MT randomized trial examined sex differences in blood pressure (BP) and outcomes among adults with acute ischemic stroke, successful endovascular thrombectomy (EVT), and persistently elevated systolic BP. Among 816 participants, intensive BP management was associated with worse 90-day ordinal modified Rankin Scale outcomes in males (adjusted common odds ratio [acOR] 1.91; 95% CI 1.29-2.83), but not clearly in females (acOR 0.94; 95% CI 0.56-1.57). The treatment association differed by sex, but the findings are exploratory and hypothesis generating.
Key findings
- Intensive BP management was associated with worse 90-day ordinal mRS outcomes in males (acOR 1.91; 95% CI 1.29-2.83), with a closer-to-null estimate in females (acOR 0.94; 95% CI 0.56-1.57).
- The ratio of treatment acORs for males versus females was 0.49 (95% CI 0.26-0.94).
- Each 5 mm Hg higher mean SBP was associated with worse 90-day mRS in males (acOR 1.11; 95% CI 1.03-1.20), but no clear adverse association was observed in females (acOR 0.95; 95% CI 0.85-1.05).
- SBP variability showed weaker and less consistent sex-differential associations; secondary-outcome findings were exploratory.
Why it matters
The analysis suggests that associations between early post-EVT BP management and functional outcome may differ by sex, underscoring the importance of examining treatment effects across patient groups. However, the results do not establish that sex-specific BP targets improve outcomes. They provide a rationale for prospective studies designed to test whether these observed differences are reproducible and clinically meaningful.
What to keep in mind
This was an exploratory secondary analysis, and the authors describe the findings as hypothesis generating. Sex-stratified associations may reflect differences in baseline clinical and vascular characteristics; prospective confirmation is needed.