Systolic blood pressure and early neurological deterioration in minor stroke: A post hoc analysis of ARAMIS trial

Abstract Background Systolic blood pressure (SBP) was a predictor of early neurological deterioration (END) in stroke. We performed a secondary analysis of ARAMIS trial to investigate whether baseline SBP affects the effect of dual antiplatelet versus intravenous alteplase on END. Methods This post hoc analysis included patients in the as‐treated analysis set. According to SBP at admission, patients were divided into SBP ≥140 mmHg and SBP <140 mmHg subgroups. In each subgroup, patients were further classified into dual antiplatelet and intravenous alteplase treatment groups based on study drug actually received. Primary outcome was END, defined as an increase of ≥2 in the NIHSS score from baseline within 24 h. We investigated effect of dual antiplatelet vs intravenous alteplase on END in SBP subgroups and their interaction effect with subgroups. Results A total of 723 patients from as‐treated analysis set were included: 344 were assigned into dual antiplatelet group and 379 into intravenous alteplase group. For primary outcome, there was more treatment effect of dual antiplatelet in SBP ≥140 mmHg subgroup (adjusted RD, −5.2%; 95% CI, −8.2% to −2.3%; p < 0.001) and no effect in SBP <140 mmHg subgroup (adjusted RD, −0.1%; 95% CI, −8.0% to 7.7%; p = 0.97), but no significant interaction between subgroups was found (adjusted p = 0.20). Conclusions Among patients with minor nondisabling acute ischemic stroke, dual antiplatelet may be better than alteplase with respect to preventing END within 24 h when baseline SBP ≥140 mmHg.