Blood Pressure in the First 6 Hours for Older Adults with Stroke after Endovascular therapy: A Pooled Analysis of the DEVT and RESCUE BT Randomized Clinical Trials

Background Optimal systolic blood pressure (SBP) targets after endovascular therapy (EVT) for stroke in older adults (≥ 65 years) remain undefined. This study assessed age-stratified associations between early post-EVT SBP (first 6 hours) and outcomes. Methods Post hoc analysis of two trials. Patients were stratified by age (18–64 vs. ≥65 years) and SBP (≤ 120, 120–140, > 140 mmHg). Primary outcome was 90-day functional status (modified Rankin Scale, mRS). Inverse probability treatment weighting (IPTW) and multivariable regression adjusted for confounders. Results Post-EVT SBP data were available for 267 young and 395 old patients. IPTW analysis revealed that sustained SBP below 120 mmHg during the first 6 hours post-EVT significantly enhanced functional independence in elderly patients (common OR: 2.00; 95% CI: 1.18–3.39). Among young cohorts, maintenance of SBP ≤ 120 mmHg (cOR, 2.89; 95% CI, 1.45–5.82) and 120–140 mmHg (cOR, 3.18; 95% CI, 1.58–6.47) were associated with a better outcome. sICH incidence demonstrated no statistically significant association with systolic blood pressure (SBP) levels ( P  = 0.21; 95% CI: 0.93–1.35). Conclusions During the initial 6-hour window post- EVT, younger patients achieving SBP levels ≤ 140 mmHg and elderly patients maintaining SBP ≤ 120 mmHg demonstrated significantly improved clinical outcomes. These results suggest that stricter blood pressure control may be particularly beneficial for older adults in the early post-EVT phase. The DEVT registration: URL: http://www.chictr.org.cn; Chinese Clinical Trial Registry: ChiCTR-IOR-17013568, and the RESCUE BT registration: URL: http://www.chictr.org.cn; ChiCTR-INR-17014167.