Effects of early intensive blood pressure lowering on early reperfusion and outcome after intravenous thrombolysis in patients with acute ischemic stroke

Abstract

Objective To investigate the effects of intensive antihypertensive treatment and guideline-recommended standard blood pressure control on early reperfusion and outcomes after intravenous recombinant tissue plasminogen activator (rtPA) thrombolysis in patients with acute ischemic stroke. Methods A total of 50 patients with acute ischemic stroke (systolic blood pressure, 150-185 mmHg; 1 mmHg=0.133 kPa) and received intravenous rtPA therapy were enrolled prospectively. They were randomly divided into either a intensive antihypertensive treatment group or a guideline antihypertensive treatment group. In the the intensive antihypertensive treatment group, systolic blood pressure was decreased to 140-150 mmHg in 60 min for at least 72 h. In the guideline antihypertensive treatment group, systolic blood pressure was decreased to the target value <180 mmHg according to the guideline recommendation. Multi-mode MRI was completed at 24 h before and after thrombolysis. The primary endpoints were the modified Rankin Scale (mRS) score at day 90 and the mortality at day 90; the secondary endpoints were the early reperfusion rate in ischemic brain tissue, recanalization rate, and incidence of symptomatic intracranial hemorrhage. Results There was no significant difference in demographics and baseline data between the 2 groups. Within 24, 48, and 72 h after thrombolysis the mean systolic blood pressure in the intensive antihypertensive treatment group was significantly lower than those in the guideline antihypertensive treatment group, while there was no significant difference in diastolic blood pressure. There were no significant differences in favorable outcome rate at day 90 (mRS score 0-2: 68% vs. 64%; χ2=0.089, P=0.765), mortality (4% vs. 12%; χ2=1.087, P=0.297), incidence of symptomatic intracranial hemorrhage (4% vs. 8%; χ2=0.355, P=0.552), reperfusion rate after thrombolysis (76% vs. 68%; χ2=0.397, P=0.529), and recanalization rate (56% vs. 52%; χ2=0.081, P=0.777) between the intensive antihypertensive treatment group and the guideline antihypertensive treatment group. Conclusions Early intensive antihypertensive treatment in patients with acute ischemic stroke received intravenous rtPA thrombolysis does not have adverse effect on reperfusion rate, and does not increase the risk of death or disability either. Key words: Stroke; Brain Ischemia; Thrombolytic Therapy; Tissue Plasminogen Activator; Hypertension; Blood Pressure; Antihypertensive Agents; Treatment Outcome; Time Factors