Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

Abstract

There are concerns that specific risk factors may alter the benefits of thrombolysis in stroke patients with controlled contraindications including hypertension. The objective of this study was to evaluate the association between clinical risk factors and outcomes in ischemic stroke patients that received thrombolysis therapy pretreated with antihypertensive medications. Using data obtained from a stroke registry, a non‐randomized retrospective data analysis was conducted on patients with the primary diagnosis of acute ischemic stroke with hypertension pretreated with antihypertensive medications. The association between clinical risk factors and functional ambulatory outcome was determined using logistic regression while odd ratios (OR) were used to predict the odds of achieving improved ambulatory outcome in thrombolysis treatment status. Improved or poor functional ambulatory outcome was considered as the end point in our analysis. A total of 4665 acute ischemic stroke patients were identified, of whom 1446 (31.0%) were eligible for thrombolysis, while 3219 were not, and 595 received rtPA, of whom 288 were on antihypertensive medications, while 233 were not. In the rtPA group with antihypertensive (anti‐HTN) medication, only NIHSS score (OR = 1.094, 95% CI, 1.094‐1.000, P = 0.005) was associated with improved functional outcome while patients with congestive heart failure (OR = 0.385, 95% CI, 0.385‐0.159, P = 0.035) and patients with a history of previous TIA (OR = 0.302, 95% CI, 0.302‐0.113, P = 0.017) were more likely to be associated with poor functional outcomes. Congestive heart failure and TIA are independent predictors of functional outcomes in stroke patients pretreated with antihypertensive medications prior to thrombolysis therapy.

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

“…And even minor fluctuations in BP may lead to important changes in cerebral perfusion via collaterals, especially in stoke with steno-occlusive arterial disease. [27][28][29] Therefore, we thought that BPV may contribute to the development of END by altering the hemodynamic status.…”

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients

“…Findings reveal that statins reduce the risk of first and recurrent ischemic strokes [4,5] and may also improve treatment outcomes through pleiotropic non-statin-associated effects [6]. Several studies [7][8][9][10][11][12] report the relationship between statin use and stroke, including related treatment outcomes. While some studies [13][14][15] report contradictory evidence that cholesterol reducers, including statins, do not reduce initial stroke severity, other studies [16][17][18] report favorable outcomes associated with statin use and stroke.…”

In acute ischemic stroke patients with smoking incidence, are more women than men more likely to be included or excluded from thrombolysis therapy?

“…Several clinical characteristics identified in male stroke patients with a history of smoking are similar to those found in other studies in male stroke patients. [23][24][25][26][27][28] For example, we found that after adjusting for age and comorbidities, male stroke patients with a history of smoking with a previous TIA and weakness are more likely to receive rtPA. This is supported by other studies where a previous TIA 29 and weakness 30 did not affect the favorable outcome following thrombolysis therapy in male stroke patients.…”