The impact of blood pressure variation on mortality and symptomatic intracerebral hemorrhage in stroke patients after thrombolytic therapy

Type of funding sources: Public Institution(s). Main funding source(s): Faculty of Medicine, Khon Kaen University

Introduction Blood pressure variation (BPV) was one of the risk factors for unfavorable stokes outcomes. However, the association between BPV and short-term outcomes in stroke patients after received thrombolysis (recombinant tissue plasminogen activator; rt-PA) was limited.

Objectives We aimed to determine the association between BPV and mortality and symptomatic intracerebral hemorrhage (s-ICH) in stroke patients after rt-PA administration.

Methods This was a cross-sectional study in a specialized stroke unit of our university hospital, during 2015-2019. Adult ischemic-stroke patients who were eligible for receiving rt-PA were enrolled. Supine BP was measured just before starting rt-PA and at 0, 4, 8, 12, 16, 20, and 24 hours after completing rt-PA administration. The standard deviation (SD), coefficient of variation (CV), and successive variation (SV) of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated. Final outcomes were in-hospital mortality, or s-ICH.

Results There were 278 patients enrolled, 138 men (49.6%), and mean age 65 ± 13 years old. Ten patients died (3.6%) and 27 patients had s-ICH (9.7%). There were 86 (30.9%) patients who received IV nicardipine before and after rt-PA. All BPV profiles of SBP were associated with mortality and s-ICH. Odds ratio (OR) for mortality were as follows; SD, 1.10 (1.02-1.19); CV, 1.13 (1.02-1.25); and SV, 1.07 (1.01-1.13), and OR for s-ICH were as follows; SD, 1.07 (1.02-1.14); CV, 1.11 (1.03-1.19); and SV, 1.05 (1.01-1.10). The BPV profiles of DBP also showed significant positive association with mortality and s-ICH. However, mean SBP and DBP, and time to rt-PA were not associated with both outcomes.

Conclusions BPV profiles of both SBP and DPB were positively associated with mortality and s-ICH in stroke patients after receiving rt-PA, independent of BP levels. Further study on the optimal BPV and the treatment towards it is crucial.