Early Blood Pressure Rise Signals Worse Stroke Outcomes

METHODOLOGY:

• Researchers in Norway conducted a post hoc analysis of a phase 3 randomised controlled trial (NOR-TEST) to evaluate the effect of 24-hour sBP trajectories on neurologic and functional outcomes in patients with acute ischaemic stroke treated with intravenous alteplase.
• They included 424 patients with acute ischaemic stroke (mean age, 70.8 years; 35.4% women) who were hospitalised within 4.5 hours of symptom onset and treated with intravenous alteplase during 2012-2016.
• The primary outcome was functional outcome at 3 months post-stroke, defined using the modified Rankin scale (mRS; good outcome, a mRS score of 0-2).
• Secondary outcomes were neurologic function evaluated using the National Institutes of Health Stroke Scale at 24 hours following alteplase treatment and symptomatic intracerebral haemorrhage reporting within 48 hours.

TAKEAWAY:

• Overall, 309 (75.1%) patients achieved a good functional outcome; those who experienced a reduction in sBP during the first 24 hours had better outcomes than those who experienced an increase in sBP during the first 24 hours (77.9% vs 69.0%; P < .001).
• An increase in sBP between baseline and 24 hours was significantly associated with worse functional outcomes at 3 months post-stroke after adjusting for variables (odds ratio [OR], 0.933; P = .03).
• Moreover, an increase in sBP within the first 24 hours (beta-coefficient [β], 0.167), higher sBP at baseline (β, 0.072), and more severe stroke symptoms at admission (β, 0.517; P < .05 for all) were associated with worse neurologic function at 24 hours.
• After adjustments, each 1 mm Hg increase in baseline sBP increased the odds of symptomatic intracerebral haemorrhage by 2.2% within 48 hours from the onset of stroke (OR, 1.022; P = .022).

The study results indicate that high blood pressure at baseline is detrimental and associated with severe outcomes. Large fluctuations in systolic blood pressure, especially increase in sBP the first 24 hours after thrombolysis should be avoided.

 

 

https://www.medscape.com/viewarticle/early-blood-pressure-rise-signals-worse-stroke-outcomes-2025a1000z2x