Blood pressure excursions in acute ischemic stroke patients
treated with intravenous thrombolysis

J 2021

Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis

TSIVGOULIS, G., A. H. KATSANOS, P. MANDAVA, M. KOHRMANN, L. SOINNE et. al.

Basic information

Original name

Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis

Authors

TSIVGOULIS, G. (guarantor), A. H. KATSANOS, P. MANDAVA, M. KOHRMANN, L. SOINNE, A. D. BARRETO, V. K. SHARMA, Robert MIKULÍK (203 Czech Republic, belonging to the institution), K. W. MUIR, T. ROTHLISBERGER, J. C. GROTTA, C. R. LEVI, C. A. MOLINA, M. SAQQUR, D. MAVRIDIS, T. PSALTOPOULOU, M. R. VOSKO, J. B. FIEBACH, E. C. SANDSET, T. A. KENT, A. W. ALEXANDROV, P. D. SCHELLINGER and A. V. ALEXANDROV

Edition

Journal of Hypertension, PHILADELPHIA, William and Wilkins, 2021, 0263-6352

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.776

RIV identification code

RIV/00216224:14110/21:00121365

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1097/HJH.0000000000002628

UT WoS

000612619500011

Keywords in English

blood pressure; intracranial hemorrhage; monitoring; outcome; sonothrombolysis; stroke; thrombolysis

Abstract

V originále

Objective: To investigate the association of blood pressure BP excursions, defined as greater than 185 SBP or greater than 105 DBP, with the probability of intracranial hemorrhage (ICH) and worse functional outcomes in patients with acute ischemic stroke (AIS) treated with tissue plasminogen activator (tPA). Methods: We performed a post hoc analysis of the CLOTBUST-ER trial. Serial BP measurements were conducted using automated cuff recording according to the recommended BP protocol guidelines for tPA administration. The outcomes were prespecified efficacy and safety endpoints of CLOTBUST-ER. Results: The mean number of serial BP recordings per patient was 37. Of the 674 patients, 227 (34%) had at least one BP excursion (>185/105 mmHg) during the first 24 h following tPA-bolus. The majority of BP excursions (46%) occurred within the first 75min from tPA-bolus. Patients with at least one BP excursion in the first 24 h following tPA bolus had significantly lower rates of independent functional outcome at 90 days (31 vs. 40.1%, P = 0.028). The total number of BP excursions was associated with decreased odds of 24-h clinical recovery (OR = 0.88, 95% CI:0.80-0.96), 24-h neurological improvement (OR = 0.87, 95% CI: 0.81-0.94), 7-day functional improvement (common OR = 0.92, 95% CI: 0.87-0.97), 90-day functional improvement (common OR = 0.94, 95% CI: 0.88-0.98) and 90-day independent functional outcome (OR = 0.90, 95% CI: 0.82-0.98) in analyses adjusted for potential confounders. DBP excursions were independently associated with increased odds of any intracranial hemorrhage (OR = 1.26, 95% CI: 1.04-1.53). Conclusion: BP excursions above guideline thresholds during the first 24 h following tPA administration for AIS are common and are independently associated with adverse clinical outcomes.

Citovat

TSIVGOULIS, G., A. H. KATSANOS, P. MANDAVA, M. KOHRMANN, L. SOINNE, A. D. BARRETO, V. K. SHARMA, Robert MIKULÍK, K. W. MUIR, T. ROTHLISBERGER, J. C. GROTTA, C. R. LEVI, C. A. MOLINA, M. SAQQUR, D. MAVRIDIS, T. PSALTOPOULOU, M. R. VOSKO, J. B. FIEBACH, E. C. SANDSET, T. A. KENT, A. W. ALEXANDROV, P. D. SCHELLINGER and A. V. ALEXANDROV. Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis. Journal of Hypertension. PHILADELPHIA: William and Wilkins, 2021, vol. 39, No 2, p. 266-272. ISSN 0263-6352. Available from: https://dx.doi.org/10.1097/HJH.0000000000002628.

@article{1758077,
   author = {Tsivgoulis, G. and Katsanos, A. H. and Mandava, P. and Kohrmann, M. and Soinne, L. and Barreto, A. D. and Sharma, V. K. and Mikulík, Robert and Muir, K. W. and Rothlisberger, T. and Grotta, J. C. and Levi, C. R. and Molina, C. A. and Saqqur, M. and Mavridis, D. and Psaltopoulou, T. and Vosko, M. R. and Fiebach, J. B. and Sandset, E. C. and Kent, T. A. and Alexandrov, A. W. and Schellinger, P. D. and Alexandrov, A. V.},
   article_location = {PHILADELPHIA},
   article_number = {2},
   doi = {http://dx.doi.org/10.1097/HJH.0000000000002628},
   keywords = {blood pressure; intracranial hemorrhage; monitoring; outcome; sonothrombolysis; stroke; thrombolysis},
   language = {eng},
   issn = {0263-6352},
   journal = {Journal of Hypertension},
   title = {Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis},
   url = {https://journals.lww.com/jhypertension/Fulltext/2021/02000/Blood_pressure_excursions_in_acute_ischemic_stroke.11.aspx},
   volume = {39},
   year = {2021}
}

TY  - JOUR
ID  - 1758077
AU  - Tsivgoulis, G. - Katsanos, A. H. - Mandava, P. - Kohrmann, M. - Soinne, L. - Barreto, A. D. - Sharma, V. K. - Mikulík, Robert - Muir, K. W. - Rothlisberger, T. - Grotta, J. C. - Levi, C. R. - Molina, C. A. - Saqqur, M. - Mavridis, D. - Psaltopoulou, T. - Vosko, M. R. - Fiebach, J. B. - Sandset, E. C. - Kent, T. A. - Alexandrov, A. W. - Schellinger, P. D. - Alexandrov, A. V.
PY  - 2021
TI  - Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis
JF  - Journal of Hypertension
VL  - 39
IS  - 2
SP  - 266-272
EP  - 266-272
PB  - William and Wilkins
SN  - 02636352
KW  - blood pressure
KW  - intracranial hemorrhage
KW  - monitoring
KW  - outcome
KW  - sonothrombolysis
KW  - stroke
KW  - thrombolysis
UR  - https://journals.lww.com/jhypertension/Fulltext/2021/02000/Blood_pressure_excursions_in_acute_ischemic_stroke.11.aspx
N2  - Objective: To investigate the association of blood pressure BP excursions, defined as greater than 185 SBP or greater than 105 DBP, with the probability of intracranial hemorrhage (ICH) and worse functional outcomes in patients with acute ischemic stroke (AIS) treated with tissue plasminogen activator (tPA). Methods: We performed a post hoc analysis of the CLOTBUST-ER trial. Serial BP measurements were conducted using automated cuff recording according to the recommended BP protocol guidelines for tPA administration. The outcomes were prespecified efficacy and safety endpoints of CLOTBUST-ER. Results: The mean number of serial BP recordings per patient was 37. Of the 674 patients, 227 (34%) had at least one BP excursion (>185/105 mmHg) during the first 24 h following tPA-bolus. The majority of BP excursions (46%) occurred within the first 75min from tPA-bolus. Patients with at least one BP excursion in the first 24 h following tPA bolus had significantly lower rates of independent functional outcome at 90 days (31 vs. 40.1%, P = 0.028). The total number of BP excursions was associated with decreased odds of 24-h clinical recovery (OR = 0.88, 95% CI:0.80-0.96), 24-h neurological improvement (OR = 0.87, 95% CI: 0.81-0.94), 7-day functional improvement (common OR = 0.92, 95% CI: 0.87-0.97), 90-day functional improvement (common OR = 0.94, 95% CI: 0.88-0.98) and 90-day independent functional outcome (OR = 0.90, 95% CI: 0.82-0.98) in analyses adjusted for potential confounders. DBP excursions were independently associated with increased odds of any intracranial hemorrhage (OR = 1.26, 95% CI: 1.04-1.53). Conclusion: BP excursions above guideline thresholds during the first 24 h following tPA administration for AIS are common and are independently associated with adverse clinical outcomes.
ER  -

TSIVGOULIS, G., A. H. KATSANOS, P. MANDAVA, M. KOHRMANN, L. SOINNE, A. D. BARRETO, V. K. SHARMA, Robert MIKULÍK, K. W. MUIR, T. ROTHLISBERGER, J. C. GROTTA, C. R. LEVI, C. A. MOLINA, M. SAQQUR, D. MAVRIDIS, T. PSALTOPOULOU, M. R. VOSKO, J. B. FIEBACH, E. C. SANDSET, T. A. KENT, A. W. ALEXANDROV, P. D. SCHELLINGER and A. V. ALEXANDROV. Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis. \textit{Journal of Hypertension}. PHILADELPHIA: William and Wilkins, 2021, vol.~39, No~2, p.~266-272. ISSN~0263-6352. Available from: https://dx.doi.org/10.1097/HJH.0000000000002628.

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