The Impact of Intensive Blood Pressure Management in the Post-Thrombolysis Setting: a real-world observational study

IntroductionSystolic Blood pressure (SBP) >180mmHg following stroke thrombolysis has been associated with increased bleeding and poorer outcome. Aiming for the guideline SBP of <180mmHg often leads to SBP overshoot as treatment is only triggered if this threshold is passed. We tested whether a lower target would result in fewer high SBP protocol violations. MethodsThis is a prospective, single centre, sequential comparison of two blood pressure protocols. Between 2013 and 2017, the guideline based post-thrombolysis SBP target of <180mmHg was compared with a new protocol aiming for 140-160mmHg. Primary outcome was rate of patients with SBPs >180 mmHg. Secondary outcomes included rate of SBP <120 mmHg, antihypertensive infusion use, symptomatic intracerebral haemorrhage (sICH), and 3-month functional independence (mRS 0-2). Results were adjusted for age, baseline function, and stroke severity using regression analysis. ResultsDuring the 23 months preceding and 18 months following the transition to the new protocol 68 and 100 patients were thrombolysed respectively. Baseline characteristics were similar between groups. The odds of one or more SBPs >180mmHg trended lower in the intensive group (adjusted odds ratio (aOR) 0.61; 95% CI 0.32-1.17; p=0.14). There was a higher rate of SBPs <120mmHg (aOR 3.09; 95% CI 1.49-6.40; p=0.002) in the intensive BP protocol group. sICH rate and 3-month mRS 0-2 were similar between groups. ConclusionsThe more intensive post-thrombolysis BP protocol led to a significant increase in sub-optimally low BP events with a non-significant trend toward fewer high BP protocol violations and unaffected patient outcomes.