Abstract WP102: Association of Elevated Blood Pressure Levels With Outcomes in Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis: A Systematic Review and Meta-Analysis

Abstract

Introduction: Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes. Methods: We identified eligible studies involving IVT-treated AIS patients that reported the association of mean systolic (SBP) or diastolic BP (DBP) levels before and after IVT with the following outcomes: three-month favorable functional outcome (FFO; mRS-scores of 0-1), three-month functional independence (FI; mRS-scores of 0-2)], three-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences (SMD) for individual outcomes and adjusted analyses of studies reporting odds ratios (ORadj) per 10mmHg BP increment were performed using the random-effects models. Results: We identified 26 studies comprising 56,513 patients. Higher pre- (SMD: 0.24; 95%CI: 0.04 to 0.43; p=0.02) and post-treatment (SMD: 0.50; 95%CI: 0.14 to 0.86; p=0.006) SBP levels were observed in patients with sICH. Patients with 3-month FI had lower pre- (SMD: -0.18; 95%CI: -0.34 to -0.01; p=0.04) and post-treatment (SMD: -0.19; 95%CI: -0.23 to -0.15; p<0.001) SBP. In adjusted analyses, elevated pre- (ORadj: 1.08; 95%CI: 1.01 to 1.16) and post-treatment (ORadj: 1.13; 95%CI: 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj: 0.91; 95%CI: 0.84 to 0.98) and post-treatment (ORadj: 0.70; 95%CI: 0.57 to 0.87) SBP values were also related to lower odds of 3-month FI. No association was noted between either mean pre-treatment or post-treatment SBP levels with three-month mortality. Likewise, no associations were observed with either mean pre-treatment or post-treatment DBP levels and three-month FFO, three-month FI, sICH, or three-month mortality. Conclusions: We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data regarding the potential association of BP control with improved outcomes of AIS patients treated with IVT.