What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke (n=28976). Intervention: 24-hour blood pressure variability. Primary outcome: Early neurological improvement, symptomatic intracerebral hemorrhage, and long-term functional outcome (mRS at 90 days) (p=<0.01).

May 26, 2017Open Access

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Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis

Q: What are the key findings of this study?

24-hour blood pressure variability significantly impacted clinical outcomes in acute ischemic stroke patients treated with intravenous thrombolysis (P<0.01).

LKLars KellertDementia UK CHChristian HametnerUniversity of Würzburg NANiaz AhmedKarolinska University Hospital

Key Result

24-hour blood pressure variability significantly impacted clinical outcomes in acute ischemic stroke patients treated with intravenous thrombolysis (P<0.01).

Study Design

Type

Observational (n=28,976)

Multicenter

Yes

Structured PICO

Does 24-hour blood pressure variability impact outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis?

Population

28,976 patients with acute ischemic stroke treated with intravenous thrombolysis, with documented pre-treatment systolic BP at 2 and 24 hours from the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry

Intervention

24-hour blood pressure variability (BPV)

Outcome

Early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale [mRS] at 90 days)hard clinical

Individualized blood pressure management accounting for pre-treatment BP and acute BP variability may be needed to optimize outcomes in acute ischemic stroke patients undergoing thrombolysis.

Main Result

p-value: p=<0.01

Abstract

BACKGROUND AND PURPOSE: Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. METHODS: From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed. The primary measure of BP variability was successive variability. Data were preprocessed using coarsened exact matching. We assessed early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale mRS at 90 days) by binary and ordinal regression analyses. RESULTS: <0.01). Excluding patients with atrial fibrillation in a sensitivity analysis gave consistent results overall. CONCLUSIONS: This study suggests the need for a more individual BP management accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient.

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Cite This Study

Kellert et al. (Fri,) conducted a observational in Acute ischemic stroke (n=28,976). 24-hour blood pressure variability was evaluated on Early neurological improvement, symptomatic intracerebral hemorrhage, and long-term functional outcome (mRS at 90 days) (p=<0.01). 24-hour blood pressure variability significantly impacted clinical outcomes in acute ischemic stroke patients treated with intravenous thrombolysis (P<0.01).

synapsesocial.com/papers/6a0663ffcc83fae8617783bb https://doi.org/https://doi.org/10.1161/strokeaha.117.016876