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.
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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
Original language English
Type of outcome Article in a journal
Field of Study 30201 Cardiac and Cardiovascular systems
Country of publisher United States of America
Confidentiality degree is not subject to a state or trade secret
WWW 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
Tags 14110127, rivok
Tags International impact, Reviewed
Changed by Changed by: Mgr. Tereza Miškechová, učo 341652. Changed: 7/4/2021 12:22.
Abstract
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.
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