Interaction of blood pressure in patients with vascular stenosis of intravenous thrombolytic stroke
1Department of Neurology, Minhang Hospital, Fudan University, 201199 Shanghai, China
2Department of Neurology, the Second Affiliated Hospital of Soochow University, 215004 Suzhou, Jiangsu, China
DOI: 10.22514/sv.2022.062 Vol.18,Issue 5,September 2022 pp.138-144
Submitted: 21 July 2022 Accepted: 16 August 2022
Published: 08 September 2022
† These authors contributed equally.
The prognostic relationship between blood pressure (BP) and ischemic stroke remains controversial in patients receiving intravenous thrombolysis (IVT), and it is unclear whether vascular stenosis could influence this association. The systolic BP data within 24 hours of IVT in 465 ischemic stroke patients were obtained from the Soochow Stroke Registry System database and the mean BP measurements 24 hours after thrombolysis were stratified. Patients who received intravenous thrombolysis were divided into two groups: with or without vascular stenosis ≥70%. The study outcomes were death, major disability (modified Rankin Scale (mRS) 3–6) and intracranial hemorrhagic transformation 3 months after IVT. A “J”-shaped relationship was observed between mean systolic BP within 24 hours of IVT and 3-month clinical outcomes in patients with vessel stenosis ≥70%. Systolic BP between 130–140 mmHg was associated with lowest risk of poor clinical outcomes. Patients with the lowest mean systolic BP (<130 mmHg) had 4.94 times higher risk of poor prognosis compared to those with systolic blood pressure (SBP) between 130–140 mmHg (Odd ratio (OR) 4.94; 95% confidence interval (CI) 1.01 to 24.20; p = 0.049), and patients with highest mean systolic BP (≥150 mmHg) had 22.12 times higher risk of poor prognosis than patients with mean systolic BP between 130–140 mmHg (OR 22.12; 95% CI 3.62–135.30, p < 0.001). However, we observed no relationship between BP within 24 hours of IVT and clinical outcome in patients without vascular stenosis ≥70% (Ptrend = 0.780). A “J”-shaped relationship was observed between mean systolic BP and prognosis in patients with severe stenosis, and those with lowest mean systolic BP between 130–140 mmHg had least risk of poor prognosis.
Stroke; Intravenous thrombolysis; Blood pressure; Vascular stenosis; Prognosis
Xueyu Mao,Zhouhang Liu,Delong Wang,Shiliang Xia,Shidong Wei,Yongjun Cao,Jin Zheng. Interaction of blood pressure in patients with vascular stenosis of intravenous thrombolytic stroke. Signa Vitae. 2022. 18(5);138-144.
 GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the global burden of disease study 2019. The Lancet Neurology. 2021; 20: 795–820.
 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the american heart association/American stroke association. Stroke. 2018; 49: e46–e110.
 Yong M, Kaste M. Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial. Stroke. 2008; 39: 366–372.
 He J, Zhang Y, Xu T, Zhao Q, Wang D, Chen CS, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized 302 clinical trial. JAMA. 2014; 311: 479–489.
 IST-3 collaborative group, Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012; 379: 2352–2363.
 Malhotra K, Ahmed N, Filippatou A, Katsanos AH, Goyal N, Tsioufis K, et al. Association of elevated blood pressure levels with outcomes in acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis. Journal of Stroke. 2019; 21: 78–90.
 Ahmed N, Wahlgren N, Brainin M, Castillo J, Ford GA, Kaste M, et al. 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.
 Li C, Wang Y, Chen Y, Zhang C, Dong Z, Zhang S, et al. Optimal blood pressure levels in patients undergoing intravenous thrombolysis for AIS. Minerva Medica. 2015; 106: 255–258.
 Anderson CS, Huang Y, Lindley RI, Chen X, Arima H, Chen G, et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. The Lancet. 2019; 393: 877–888.
 Wahlgren N, Ahmed N, Dávalos A, Hacke W, Millán M, Muir K, et al. Thrombolysis with alteplase 3–4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. The Lancet. 2008; 372: 1303–1309.
 Kellert L, Hametner C, Ahmed N, Rauch G, MacLeod MJ, Perini F, et al. Reciprocal interaction of 24-hour blood pressure variability and systolic blood pressure on outcome in stroke thrombolysis. Stroke. 2017; 48: 1827–1834.
 Hong L, Cheng X, Lin L, Bivard A, Ling Y, Butcher K, et al. The blood pressure paradox in acute ischemic stroke. Annals of Neurology. 2019; 85: 331–339.
 Coutts SB, Dubuc V, Mandzia J, Kenney C, Demchuk AM, Smith EE, et al. Tenecteplase-tissue-type plasminogen activator evaluation for minor ischemic stroke with proven occlusion. Stroke. 2015; 46: 769–774.
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