Key result
Slow drop-low level (OR 5.239) and continuous fluctuation-very high level (OR 3.797) systolic blood pressure trajectories within 24 hours of alteplase increased unfavorable 3-month outcome risk.
Why the study?
Blood pressure monitored within 24 hours of alteplase is important for AIS prognosis, but longitudinal BP trajectory patterns and their association with stroke outcomes required exploration.
Do specific 24-hour blood pressure trajectory patterns predict prognosis in patients with acute ischemic stroke treated with intravenous alteplase?
Cohort (n=353)
No
Do specific 24-hour blood pressure trajectory patterns predict prognosis in patients with acute ischemic stroke treated with intravenous alteplase?
Answers are grounded in this paper and cite their sources.
Specific 24-hour blood pressure trajectories after alteplase administration in acute ischemic stroke patients are significantly associated with early neurological changes and 3-month functional outcomes.
Blood pressure (BP) monitored within 24 h from the beginning of intravenous thrombolysis (IVT) with alteplase, is one of the important factors affecting the prognosis of patients with acute ischemic stroke (AIS). This study aimed to explore longitudinal BP trajectory patterns and determine their association with stroke prognosis after thrombolysis. From November 2018 to September 2019, a total of 391 patients were enrolled consecutively during the study period, and 353 patients were ultimately analyzed. Five systolic (SBP) and four diastolic blood pressure (DBP) trajectory subgroups were identified. The regression analysis showed that when compared with the rapidly moderate stable group, the continuous fluctuation-very high level SBP group (odds ratio [OR]: 2.743, 95% confidence interval [CI]: 1.008-7.467) was associated with early neurological deterioration (END). Both the rapid drop-high level SBP (OR: 0.448, 95% CI: 0.219-0.919) and DBP groups (OR: 0.399, 95% CI: 0.219-0.727) were associated with early neurological improvement (ENI). Moreover, there was a U-shaped correlation between the OR value of SBP trajectory group and favorable outcome (the modified Rankin Scale [mRS] score 0-2) at 3 months: the slow drop-low level SBP group represent a well-established unfavorable outcome risk factor (OR:5.239, 95% CI: 1.271-21.595), and extremely high SBP-the continuous fluctuation-very high level SBP group, are equally associated with elevated unfavorable outcome risk (OR:3.797, 95% CI: 1.486-9.697). The continuous fluctuation-very high level DBP group was statistically significant in mRS (OR: 3.387, CI: 1.185-9.683). The BP trajectory groups show varying clinical features and risk of neurological dysfunction. The findings may help identify potential candidates for clinical BP monitoring, control, and specialized care.
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Fan et al. (2021) conducted a cohort in Acute ischemic stroke (n=353). Slow drop-low level systolic blood pressure trajectory vs. Rapidly moderate stable systolic blood pressure trajectory was evaluated on Unfavorable outcome (modified Rankin Scale score 3-6) at 3 months (OR 5.239, 95% CI 1.271-21.595). Slow drop-low level (OR 5.239) and continuous fluctuation-very high level (OR 3.797) systolic blood pressure trajectories within 24 hours of alteplase increased unfavorable 3-month outcome risk.
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