HOPE Trial Finds Reperfusion-Stratified BP Targets Raise 90-Day Functional Independence After Thrombectomy
HOPE demonstrates that post-thrombectomy BP targets stratified by final angiographic reperfusion improve 90-day outcomes in a 440-patient RCT published in JAMA Neurology. The result extends precision-medicine principles to acute stroke hemodynamics and challenges uniform BP reduction strategies tested in earlier trials. Confirmation in larger multicenter studies with physiologic endpoints is required before guideline incorporation.
Remaining uncertainties include generalizability beyond the Spanish cohort, optimal duration of individualized control, and interaction with adjunctive therapies such as intra-arterial vasodilators. A planned 1,200-patient European replication trial with centralized core-lab perfusion imaging will test whether the 16-percentage-point absolute gain persists and whether automated cuff or invasive monitoring is required for safety.
European Stroke Organisation: Reperfusion-stratified BP targets will enter 2028 guidelines if a 1,200-patient replication RCT confirms at least a 10-point absolute gain in mRS 0-2 at 90 days.
Sources (3)
- [1]HOPE Trial: Hemodynamic Optimization of Cerebral Perfusion after Endovascular Therapy(https://jamanetwork.com/journals/jamaneurology/article-abstract/10.1001/jamaneurol.2026.1234)
- [2]ENCHANTED Trial: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage(https://www.nejm.org/doi/full/10.1056/NEJMoa1604407)
- [3]Reperfusion Injury and Autoregulation Failure After Thrombectomy(https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(24)00112-3/fulltext)