Interaction of blood pressure in patients with vascular stenosis of intravenous thrombolytic stroke

Abstract

The prognostic relationship between blood pressure (BP) and ischemic stroke remains controversial in patients receiving intravenous thrombolysis (IVT), and it is unclear whether vascular stenosis could influence this association. The systolic BP data within 24 hours of IVT in 465 ischemic stroke patients were obtained from the Soochow Stroke Registry System database and the mean BP measurements 24 hours after thrombolysis were stratified. Patients who received intravenous thrombolysis were divided into two groups: with or without vascular stenosis ≥70%. The study outcomes were death, major disability (modified Rankin Scale (mRS) 3–6) and intracranial hemorrhagic transformation 3 months after IVT. A “J”-shaped relationship was observed between mean systolic BP within 24 hours of IVT and 3-month clinical outcomes in patients with vessel stenosis ≥70%. Systolic BP between 130–140 mmHg was associated with lowest risk of poor clinical outcomes. Patients with the lowest mean systolic BP (<130 mmHg) had 4.94 times higher risk of poor prognosis compared to those with systolic blood pressure (SBP) between 130–140 mmHg (Odd ratio (OR) 4.94; 95% confidence interval (CI) 1.01 to 24.20; p = 0.049), and patients with highest mean systolic BP (≥150 mmHg) had 22.12 times higher risk of poor prognosis than patients with mean systolic BP between 130–140 mmHg (OR 22.12; 95% CI 3.62–135.30, p < 0.001). However, we observed no relationship between BP within 24 hours of IVT and clinical outcome in patients without vascular stenosis ≥70% (Ptrend = 0.780). A “J”-shaped relationship was observed between mean systolic BP and prognosis in patients with severe stenosis, and those with lowest mean systolic BP between 130–140 mmHg had least risk of poor prognosis.