Introduction: Elevation of post-stroke systolic blood pressure (SBP) can be a part of a compensatory mechanism to restore cerebral perfusion to the ischemic brain tissue, but comes at a risk of reperfusion injury. The ideal SBP in the 24-hour range post-IV-rtPA has been understudied. We investigated the association of different SBP parameters post-intravenous-alteplase (IV-rtPA) with the functional outcome at discharge at a tertiary care center. Methods: We performed a retrospective chart review of patients with an acute ischemic stroke treated with IV-rtPA at a comprehensive stroke center from July 2014 to March 2018. We excluded patients who underwent mechanical thrombectomy. At the comprehensive stroke center, the BP values are documented according to standard post-IV-rtPA care guidelines. We recorded the SBP values over a period of 24-hours post-IV-rtPA. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment NIHSS, atrial fibrillation, onset to treatment time, with the SBP parameters as the predictors. The primary outcome was the functional outcome at discharge. Good outcome was defined as a modified rankin scale (mRS) of ≤2 and a poor outcome as mRS of ≥3, upon discharge. Results: 84 patients met our inclusion criteria. 45 (53.57%) patients were male. The mean age was 63.50±15 years. 25 (29.76%) patients had a good outcome (mRS≤2) at discharge. In our cohort, the parameters of higher mean SBP (144.9±14 vs.135.5±18; OR, 1.06; 95% CI, 1.02-1.11; P 0.004), higher maximum SBP (176.56±17 vs.166.7±18; OR, 1.06; 95% CI, 1.02-1.1; P 0.005) and wider pulse pressure (65.5±12 vs.57.8±13; OR,1.08; 95% CI, 1.03-1.14; P 0.007) were significantly associated with a poor outcome at discharge. Parameters of SBP variability like standard deviation SBP (13.5±5 vs.11.5±4; OR, 1.17; 95% CI, 1-1.36; P 0.058), coefficient variation SBP (9.36±4 vs.8.49±3; OR, 1.11; 95% CI, 0.94-1.32; P 0.242), and SBP range (62.22±20 vs.54.68±15; OR, 1.04; 95% CI, 1-1.07; P 0.08) were not significantly associated with a poor outcome at discharge. Conclusions: Our study demonstrates an association between higher mean SBP, higher maximum SBP, and wider pulse pressure over a period of 24-hours post-IV-rtPA, and poor functional outcome upon discharge.
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