Abstract WP124: Ataste 2: Assessment of Anti-Hypertensive Treatment and Acute Stroke Treatment Efficiency 2

Abstract

Introduction: Treatment of acute ischemic stroke (AIS) with tPA must be rapid for timely cerebral reperfusion. Anti-hypertensive (AHT) medication may be required to lower blood pressures prior to tPA. Optimal AHT use and its impact on tPA times is unclear. We examined treatment with IV bolus only (IVB), IV continuous infusion only (IVCI), or both bolus and infusion (BBI) AHTs on door-to-needle time (DTN) in AIS patients eligible for IV tPA. We hypothesized that 1) DTN would be significantly longer in patients requiring IV AHT before treatment and 2) DTN would be significantly lower in patients treated with IVCI compared to IVB or BBI. Methods: We analyzed all stroke codes who received IV tPA at our comprehensive stroke center from July 1, 2008 to June 30, 2019. Subjects were grouped by those that required IV AHT prior to IV tPA (med+tPA) and those that did not (no-med+tPA). The three medication groups were IVB, IVCI, or BBI. Variables examined were initial and immediate pre-treatment blood pressures, NIHSS, mRS, and initial blood glucose. The primary outcome was DTN between groups. Results: Overall, 288 patients were included in the analysis. Approximately 12% (n=35) of patients required IV AHTs before tPA. There was a significant difference between the med+tPA and no-med+tPA groups in 1) median NIHSS (12.5, 10; p=0.040) and initial mean glucose (142, 122.5; p<0.001), respectively. DTN was significantly longer in med+tPA vs no-med+tPA mean (77.5 min, 56.4 min; p=0.036). Systolic blood pressures (SBP) were significantly higher in patients requiring AHT treatment (initial SBP: med+tPA 175.5 mmHg, no-med-tPA 144.1 mmHg, p=0.001). There was no difference in DTN between IVB, IVCI, or BBI groups when compared to the no-med+tPA group (p=0.351, 1.000, & 0.997). There was no difference in the 90-day mRS between IVB, IVCI, or BBI compared to control (p=0.236, 0.339, & 0.326). Conclusions: Fewer patients required AHT than expected suggesting lower rates of baseline hypertension in our region. Type of AHT agent used did not significantly impact DTN. This may be due to the small sample size of patients receiving blood pressure medication prior to tPA in this study. Further prospective studies are needed to examine the optimal AHT treatment modality on DTN.