Association between post-thrombectomy blood pressure trajectories and clinical outcomes in hypertensive patients with acute ischemic stroke: a retrospective cohort study.

The impact of blood pressure (BP) trajectories after mechanical thrombectomy (MT) on functional outcomes in hypertensive patients with acute ischemic stroke (AIS) remains unclear. This single-center retrospective study included 346 hypertensive patients with anterior circulation large vessel occlusion who achieved successful recanalization (mTICI ≥2b). Group-based trajectory modeling was applied to identify distinct systolic BP (SBP) trajectories based on hourly measurements over 24 h post-MT, and their association with 90-day outcomes was assessed. Five SBP trajectories were identified: low (26.5%), moderate-to-low (6.1%), moderate (41.6%), high-to-moderate (21.5%), and high (4.3%). After multivariable adjustment, higher SBP trajectories were significantly associated with increased risks of poor functional outcome (modified Rankin Scale score > 2; P for trend = 0.014) and all-cause mortality (P for trend = 0.013). Specifically, the high-to-moderate trajectory was linked to a higher risk of disability (OR 3.46, 95% CI 0.95-4.11), while the high trajectory significantly increased mortality risk (HR 7.30, 95% CI 1.47-36.02). No significant association was found with symptomatic intracranial hemorrhage. In conclusion, post-MT SBP trajectories are independently associated with 90-day functional outcomes and mortality in hypertensive AIS patients. Sustained high SBP levels carry the greatest risk, underscoring the importance of dynamic BP monitoring and individualized management in the acute post-thrombectomy phase.