A Fall in Systolic Blood Pressure 24 Hours after Thrombolysis for Acute Ischemic Stroke Is Associated with Early Neurological Recovery

Background: Outcomes are worse in patients who underwent thrombolysis for acute ischemic stroke (AIS) with persistent hypertension. The objective of this study is to investigate whether fall in systolic blood pressure (SBP) has any relationship with neurological outcome 24 hours after thrombolysis, after adjusting for potentially confounding factors. Methods: Retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysis was used to explore the relationship between fall in SBP and reduction in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis. Other potentially confounding predictor variables used in the model were SBP on thrombolysis, blood glucose level on thrombolysis, NIHSS score on thrombolysis, administration of antihypertensive medications, and the time to thrombolysis after symptom onset. Results: A fall in SBP 24 hours after thrombolysis is independently associated with greater improvement in NIHSS score 24 hours after thrombolysis (coefficient .051, 95% confidence interval .023-.078, P < .001). Thus, a reduction of 10 mmHg in SBP after 24 hours is associated with a .51 point reduction in the NIHSS score. Conclusions: Restoration of SBP toward normal limits after thrombolysis for AIS is associated with greater early neurological improvement. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.