TY - JOUR
T1 - Blood pressure excursions in acute ischemic stroke patients treatedwith intravenous thrombolysis
AU - Tsivgoulis, Georgios
AU - Katsanos, Aristeidis H.
AU - Mandava, Pitchaiah
AU - Kohrmann, Martin
AU - Soinne, Lauri
AU - Barreto, Andrew D.
AU - Sharma, Vijay K.
AU - Mikulik, Robert
AU - Muir, Keith W.
AU - Rothlisberger, Travis
AU - Grotta, James C.
AU - Levi, Christopher R.
AU - Molina, Carlos A.
AU - Saqqur, Maher
AU - Mavridis, Dimitris
AU - Psaltopoulou, Theodora
AU - Vosko, Milan R.
AU - Fiebach, Jochen B.
AU - Sandset, Else Charlotte
AU - Kent, Thomas A.
AU - Alexandrov, Anne W.
AU - Schellinger, Peter D.
AU - Alexandrov, Andrei V.
N1 - Funding Information:
R.M. has been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR). P.D.S. has received honoraria and travel support from Cerevast and Boehringer Ingelheim. J.B.F. has received consulting, and advisory board fees from BioClinica, Cerevast, Arte-mida, Biogen, BMS, and EISAI.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Objective: To investigate the association of blood pressure BP excursions, defined as greater than 185 SBP or greater than 105 DBP, with the probability of intracranial hemorrhage (ICH) and worse functional outcomes in patients with acute ischemic stroke (AIS) treated with tissue plasminogen activator (tPA). Methods: We performed a post hoc analysis of the CLOTBUST-ER trial. Serial BP measurements were conducted using automated cuff recording according to the recommended BP protocol guidelines for tPA administration. The outcomes were prespecified efficacy and safety endpoints of CLOTBUST-ER. Results: The mean number of serial BP recordings per patient was 37. Of the 674 patients, 227 (34%) had at least one BP excursion (>185/105 mmHg) during the first 24 h following tPA-bolus. The majority of BP excursions (46%) occurred within the first 75min from tPA-bolus. Patients with at least one BP excursion in the first 24 h following tPA bolus had significantly lower rates of independent functional outcome at 90 days (31 vs. 40.1%, P=0.028). The total number of BP excursions was associated with decreased odds of 24-h clinical recovery (OR=0.88, 95% CI:0.80-0.96), 24-h neurological improvement (OR=0.87, 95% CI: 0.81-0.94), 7-day functional improvement (common OR=0.92, 95% CI: 0.87-0.97), 90-day functional improvement (common OR=0.94, 95% CI: 0.88-0.98) and 90-day independent functional outcome (OR=0.90, 95% CI: 0.82-0.98) in analyses adjusted for potential confounders. DBP excursions were independently associated with increased odds of any intracranial hemorrhage (OR=1.26, 95% CI: 1.04-1.53). Conclusion: BP excursions above guideline thresholds during the first 24 h following tPA administration for AIS are common and are independently associated with adverse clinical outcomes.
AB - Objective: To investigate the association of blood pressure BP excursions, defined as greater than 185 SBP or greater than 105 DBP, with the probability of intracranial hemorrhage (ICH) and worse functional outcomes in patients with acute ischemic stroke (AIS) treated with tissue plasminogen activator (tPA). Methods: We performed a post hoc analysis of the CLOTBUST-ER trial. Serial BP measurements were conducted using automated cuff recording according to the recommended BP protocol guidelines for tPA administration. The outcomes were prespecified efficacy and safety endpoints of CLOTBUST-ER. Results: The mean number of serial BP recordings per patient was 37. Of the 674 patients, 227 (34%) had at least one BP excursion (>185/105 mmHg) during the first 24 h following tPA-bolus. The majority of BP excursions (46%) occurred within the first 75min from tPA-bolus. Patients with at least one BP excursion in the first 24 h following tPA bolus had significantly lower rates of independent functional outcome at 90 days (31 vs. 40.1%, P=0.028). The total number of BP excursions was associated with decreased odds of 24-h clinical recovery (OR=0.88, 95% CI:0.80-0.96), 24-h neurological improvement (OR=0.87, 95% CI: 0.81-0.94), 7-day functional improvement (common OR=0.92, 95% CI: 0.87-0.97), 90-day functional improvement (common OR=0.94, 95% CI: 0.88-0.98) and 90-day independent functional outcome (OR=0.90, 95% CI: 0.82-0.98) in analyses adjusted for potential confounders. DBP excursions were independently associated with increased odds of any intracranial hemorrhage (OR=1.26, 95% CI: 1.04-1.53). Conclusion: BP excursions above guideline thresholds during the first 24 h following tPA administration for AIS are common and are independently associated with adverse clinical outcomes.
KW - Blood pressure
KW - Intracranial hemorrhage
KW - Monitoring
KW - Outcome
KW - Sonothrombolysis
KW - Stroke
KW - Thrombolysis
KW - Brain Ischemia/drug therapy
KW - Tissue Plasminogen Activator/pharmacology
KW - Humans
KW - Fibrinolytic Agents/therapeutic use
KW - Treatment Outcome
KW - Stroke/drug therapy
KW - Blood Pressure/drug effects
KW - Thrombolytic Therapy
KW - Ischemic Stroke
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U2 - 10.1097/HJH.0000000000002628
DO - 10.1097/HJH.0000000000002628
M3 - Article
C2 - 32956103
AN - SCOPUS:85099321518
SN - 0263-6352
VL - 39
SP - 266
EP - 272
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 2
ER -