Background
Outcomes are worse in patients who underwent thrombolysis for acute ischemic stroke
(AIS) with persistent hypertension. The objective of this study is to investigate
whether fall in systolic blood pressure (SBP) has any relationship with neurological
outcome 24 hours after thrombolysis, after adjusting for potentially confounding factors.
Methods
Retrospective analysis of a single-center database of consecutive thrombolysis cases
for AIS. Multivariate regression analysis was used to explore the relationship between
fall in SBP and reduction in National Institutes of Health Stroke Scale (NIHSS) score
24 hours after thrombolysis. Other potentially confounding predictor variables used
in the model were SBP on thrombolysis, blood glucose level on thrombolysis, NIHSS
score on thrombolysis, administration of antihypertensive medications, and the time
to thrombolysis after symptom onset.
Results
A fall in SBP 24 hours after thrombolysis is independently associated with greater
improvement in NIHSS score 24 hours after thrombolysis (coefficient .051, 95% confidence
interval .023-.078, P < .001). Thus, a reduction of 10 mmHg in SBP after 24 hours is associated with a
.51 point reduction in the NIHSS score.
Conclusions
Restoration of SBP toward normal limits after thrombolysis for AIS is associated with
greater early neurological improvement.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA stroke study group.N Engl J Med. 1995; 333: 1581-1587
- Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.N Engl J Med. 2008; 359: 1317-1329
- Thrombolysis with alteplase 3-4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study.Lancet. 2008; 372: 1303-1309
- The association of blood pressure and collateral circulation in hyperacute ischemic stroke patients treated with intravenous thrombolysis.Cerebrovasc Dis. 2015; 39: 130-137
- Timing of recanalization after tissue plasminogen activator therapy determined by transcranial Doppler correlates with clinical recovery from ischemic stroke.Stroke. 2000; 31: 1812-1816
- Is the benefit of early recanalization sustained at 3 months? A prospective cohort study.Stroke. 2003; 34: 695-698
- Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials.Lancet. 2014; 384: 1929-1935
- Acute hypertensive response in patients with stroke: pathophysiology and management.Circulation. 2008; 118: 176-187
- Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial.Stroke. 2008; 39: 366-372
- High blood pressure in acute stroke and subsequent outcome: a systematic review.Hypertension. 2004; 43: 18-24
- Factors related to intracranial hematoma formation in patients receiving tissue-type plasminogen activator for acute ischemic stroke.Stroke. 1994; 25: 291-297
- Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II).Stroke. 2001; 32: 438-441
- Hypertension and its treatment in the NINDS rt-PA Stroke Trial.Stroke. 1998; 29: 1504-1509
- Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from safe implementation of thrombolysis in stroke-international stroke thrombolysis register (SITS-ISTR).Stroke. 2009; 40: 2442-2449
- Blood pressure and vessel recanalization in the first hours after ischemic stroke.Stroke. 2005; 36: 264-268
- Prognostic significance of blood pressure variability after thrombolysis in acute stroke.Neurology. 2008; 71: 552-558
- Statistical analysis with missing data.John Wiley & Sons, Hoboken, NJ2014
- The correlation between admission blood glucose and intravenous rt-PA-induced arterial recanalization in acute ischemic stroke: a multi-centre TCD study.Int J Stroke. 2015; 10: 1087-1092
- Development and validation of a simplified stroke-thrombolytic predictive instrument.Neurology. 2015; 85: 942-949
- Blood pressure in acute stroke. The Copenhagen Stroke Study.Cerebrovasc Dis. 2002; 13: 204-209
- Blood flow and vascular reactivity in collaterally perfused brain tissue. Evidence of an ischemic penumbra in patients with acute stroke.Stroke. 1983; 14: 332-341
Article info
Publication history
Published online: April 01, 2016
Accepted:
March 2,
2016
Received in revised form:
January 30,
2016
Received:
January 1,
2016
Footnotes
Conflicts of interest: Roland Veltkamp has received speaker honoraria, consulting honoraria, and research support from Bayer, BMS, Biogen, Boehringer Ingelheim, Daiichi Sankyo, Medtro-nic, Morphosys, and Pfizer, as well as research support from the Deutsche Forschungsgemeinschaft (VE 196/3-1) and the Else-Kroener Fresenius Stiftung.
Authors' contributions: Dipender Gill performed the literature search, created the tables, designed the study, collected the data, analyzed the data, interpreted the data, and wrote the manuscript. Thomas Cox, Adarsh Aravind, Peter Wilding, and Eleni Korompoki performed the literature search, interpreted the data, and wrote the manuscript. Roland Veltkamp designed the study, analyzed the data, interpreted the data, and revised the manuscript. Arindam Kar designed the study, collected the data, analyzed the data, interpreted the data, and revised the manuscript.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.03.002
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
