Optimal blood pressure levels in different phases of peripheral thrombolysis period in acute ischemic stroke

He, Minqiang; Wang, Hongrui; Cui, Bing; Sun, Ying; Zhang, Guanghui; He, Xu; Niu, Xiaoqin; Wang, Bei; Xu, Biao; Li, Zaipo; Hui, Rutai; Wang, Yibo

doi:10.1097/hjh.0000000000002812

Cited by 4 publications

(4 citation statements)

References 47 publications

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“…First, all patients with BP excursion had BP decreased before thrombolysis. As BP plays an important role in maintaining cerebral perfusion through collateral circulation after ischemic stroke [4,14,15], BP decline before recanalization might exacerbate hypoperfusion and infarct growth [1,16]. Second, an inverse relationship of high BP levels and the likelihood of alteplase-induced recanalization was observed previously [6,17], and patients with BP excursion might had inferior recanalization rate.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke

Du¹,

Zhang

et al. 2023

Journal of Hypertension

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Background: Blood pressure (BP) excursion on admission was common in patients with acute ischemic stroke, but its influence on thrombolysis effect was not fully evaluated. Methods: Patients with acute ischemic stroke who received thrombolysis without subsequent thrombectomy were included. Admission BP excursion was defined as higher than 185/110 mmHg. Multivariate logistic regression analysis was used to evaluate the relationship between admission BP excursion and poor outcome as well as hemorrhage rates and mortality. Poor outcome was defined as a 90-day modified Rankin Scale score 3–6. Subgroup analysis was performed according to stroke severity, which was assessed by the National Institutes of Health Stroke Scale (NIHSS) score, and hypertension status. Results: A total of 633 patients were enrolled and 240 participants (37.9%) had admission BP excursion. Admission BP excursion was associated with poor outcome [adjusted odds ratio (OR) 0.64, 95% confidence interval 0.42–0.99, P = 0.046]. No significant difference was found regarding hemorrhage rates or mortality between patients with and without admission BP excursion. In subgroup analysis, admission BP excursion was related to poor outcome in patients with NIHSS score at least 7 (adjusted OR 1.89, 95% confidence interval 1.03–3.45, P = 0.038), but not in patients with NIHSS score less than 7 (P for interaction <0.001). Conclusion: Admission BP excursion above the guideline thresholds did not increase postthrombolysis hemorrhage risk or mortality, but was associated with poor outcome, especially in patients with severe stroke.

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Section: Discussionmentioning

confidence: 99%

Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke

Du¹,

Zhang

et al. 2023

Journal of Hypertension

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“…Finally, 422 patients with AIS were eligible for this study. Study flow diagram of patients’ enrollment was as described previously [18]. This study was approved by the ethic committee of the First People's Hospital of Lianyungang City.…”

Section: Methodsmentioning

confidence: 99%

Blood pressure undulation of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis

Wang

et al. 2022

Journal of Hypertension

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Background: Evidence suggests that patients with higher blood pressure variability (BPV) have a higher risk for stroke but the relationship between BPV and stroke outcomes is unknown in those who underwent intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). The objective of this study is to investigate the association among BPV, BP values and stroke outcomes.Methods: A retrospective analysis of about 510 consecutive thrombolysis cases for AIS from January 2015 to March 2019 in a single-center database were done. Then, these patients were followed-up for 3 months. We used univariate and multivariable models to evaluate the relationship between mean BP values, BPV and the risk of stroke outcomes from prior IVT to 72 h after IVT. Meanwhile, we also used COX regression to assess the hazard ratios of stroke outcomes with BPV within 3 months. Furthermore, we tested the effect of BP level at various time-points (prior to IVT and at 0, 2, 4, 8, 12, 24, 48 and 72 h after IVT) on development of postthrombolytic stroke outcomes.Results: Higher BPV from prior IVT to 72 h after IVT was associated with higher risk of stroke outcomes within 3 months [SBPV of recurrent stroke: odds ratios (OR) ¼ 5.298, 95% confidence interval (CI) 1.339-10.968, P ¼ 0.018; DBPV of recurrent stroke: OR ¼ 6.397, 95% CI 1.576-25.958, P ¼ 0.009, respectively]. In addition, patients with recurrent stroke had significantly higher mean SBP (OR¼1.037, 95% CI 1.006-1.069, P ¼ 0.019). Furthermore, higher BP at different time points were associated with greater risk of recurrent stroke from prior IVT to 72 h after IVT. Conclusion:Higher BPV and SBP from prior IVT to 72 h after IVT was associated with higher risk of stroke outcomes within 3 months.

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“…Finally, 422 AIS patients were eligible for this study. Figure 1 showed the study flow diagram of patients’ enrollment as described previously [ 5 , 28 ]. Ethical approval for this study was taken from the ethic committee of the First People’s Hospital of Lianyungang City.…”

Section: Methodsmentioning

confidence: 99%

“…Stroke is one of the leading causes of death and disability in the world [1,2], recurrent stroke makes up almost 25% of stroke annually [3,4]. Vessel occlusion and insufficient cerebral perfusion contribute to acute ischemic stroke (AIS) [5,6]. Hemorrhagic transformation (HT) is believed to be a common complication of AIS and occurs in 10-40% of AIS [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Red blood cell distribution width in different time-points of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis

Wang

Cui

et al. 2022

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The relationship between red blood cell distribution width (RDW) in peripheral thrombolysis period and prognosis is not fully clarified in those who underwent intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Our study aimed to clarify this issue. A retrospective analysis of about 510 consecutive thrombolysis cases for AIS from January 2015 to March 2019 in a single-center database was done and followed-up for 3 months. We used univariate and multivariable models to evaluate the relationship between RDW levels at various timepoints after IVT and the occurrence risk of hemorrhagic transformation (HT) and recurrent stroke, and used COX regression to assess the hazard ratios of outcomes with RDW levels. Elevated risk of HT was found in higher tertiles of RDW (

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Optimal blood pressure levels in different phases of peripheral thrombolysis period in acute ischemic stroke

Abstract: Supplemental Digital Content is available in the text

Cited by 4 publications

References 47 publications

Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke

Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke

Blood pressure undulation of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis

Red blood cell distribution width in different time-points of peripheral thrombolysis period in acute ischemic stroke is associated with prognosis

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