Association of intensive blood pressure lowering with health-related quality of life after endovascular thrombectomy: a post-hoc analysis of the ENCHANTED2/MT trial.
Gu R, Ge M, et al. • Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation • 2026
Intensive blood pressure lowering (target <120 mmHg) after endovascular thrombectomy was associated with modestly worse health-related quality of life at 90 days, with the effect mediated mainly indirectly via worse functional outcomes.
Key Findings
Results
Intensive BP lowering (target <120 mmHg) was associated with lower EQ-5D index scores at 90 days compared to less intensive treatment (target 140-180 mmHg).
EQ-5D index scores were 0.66 in the intensive group versus 0.72 in the less intensive group
Adjusted mean difference favored less intensive treatment: 0.06 (95% CI, 0.01–0.11; P = 0.017)
Analysis was based on 685 patients with available EQ-5D data out of 816 randomized patients
Data came from ENCHANTED2/MT, an open-label, blinded-endpoint randomized trial conducted in 44 Chinese hospitals
Results
Intensive BP lowering was associated with lower EQ Visual Analogue Scale (EQ VAS) scores at 90 days compared to less intensive treatment.
EQ VAS scores were 73.01 in the intensive group versus 76.84 in the less intensive group
Adjusted mean difference favored less intensive treatment: 3.49 (95% CI, 0.38–6.60; P = 0.028)
The authors noted the EQ VAS difference was 'small in magnitude, particularly for EQ VAS relative to commonly reported thresholds for clinical importance'
HRQoL was assessed at 90 days post-randomization
Results
The association between intensive BP lowering and worse HRQoL was mainly mediated indirectly through worse functional outcomes as measured by the modified Rankin Scale (mRS).
Causal mediation analysis was performed to explore indirect and direct pathways between BP treatment and HRQoL
The mediation analysis identified mRS outcomes as the primary pathway linking intensive BP lowering to worse HRQoL
Functional outcome was measured by the modified Rankin Scale (mRS)
The mediation finding suggests the HRQoL detriment is largely a downstream consequence of poorer neurological recovery rather than a direct effect of BP lowering itself
Methods
Adults with elevated BP within 3 hours after successful reperfusion by EVT were eligible for randomization to intensive or less intensive BP targets.
816 patients were randomized across 44 Chinese hospitals
Intensive group target: systolic BP < 120 mmHg; less intensive group target: systolic BP 140–180 mmHg
The parent trial (ENCHANTED2/MT) was an open-label, blinded-endpoint randomized design
This analysis was a post-hoc exploratory analysis of the ENCHANTED2/MT trial
Discussion
Intensive BP targets of less than 120 mmHg have previously been shown to worsen functional outcomes after EVT, and this analysis extends those findings to patient-reported HRQoL.
Prior findings from ENCHANTED2/MT established that intensive BP lowering worsened functional outcomes as measured by mRS
This post-hoc analysis is the first to examine self-reported HRQoL outcomes from this trial
The authors conclude findings 'are consistent with less intensive BP targets after EVT'
The authors highlight 'the importance of incorporating patient-reported outcomes in acute stroke trials'
What This Means
This research examined whether aggressively lowering blood pressure after a stroke procedure called endovascular thrombectomy (a treatment that removes blood clots from blocked brain arteries) affects how patients feel about their own health and quality of life. The study analyzed data from a clinical trial involving 816 patients in China who had elevated blood pressure after the procedure. Patients were randomly assigned to either an intensive blood pressure target (below 120 mmHg) or a less aggressive target (140–180 mmHg), and their quality of life was measured 90 days later using standardized questionnaires.
The study found that patients in the intensive blood pressure lowering group reported modestly worse quality of life scores on both measures used — the EQ-5D index (0.66 vs. 0.72) and the EQ Visual Analogue Scale (73.01 vs. 76.84) — compared to those in the less intensive group. Further statistical analysis suggested that this difference in quality of life was largely explained by the fact that intensive blood pressure lowering led to worse physical recovery (as measured by a standard stroke disability scale), which in turn led to worse self-reported quality of life. The differences, while statistically significant, were described as modest, particularly for the visual analogue scale measure.
This research suggests that targeting very low blood pressure levels (below 120 mmHg) immediately after endovascular thrombectomy may not benefit — and may actually harm — patients' overall wellbeing and self-reported quality of life. The findings reinforce conclusions from the main trial that a less aggressive blood pressure target may be preferable after this type of stroke treatment, and they underscore the value of including patient-reported quality of life measures alongside standard clinical measures in future stroke research.
Gu R, Ge M, Wang Z, Huyan M, Wang L, Gao Y, et al.. (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 : an international journal of quality of life aspects of treatment, care and rehabilitation. https://doi.org/10.1007/s11136-026-04274-0