Association of Early Blood Pressure Levels and Outcomes in Ischemic Stroke Treated With Intravenous Thrombolysis: A Prospective Cohort Study

Abstract

Background and Purpose

Current guidelines for acute ischemic stroke (AIS) treatment recommend a lenient upper blood pressure (BP) threshold of 185/110 mmHg. However, stricter BP control has been reported to improve prognosis. This study aims to identify the optimal BP range following thrombolysis.

Methods

This observational study included 340 AIS patients treated with rt-PA thrombolysis at the First Affiliated Hospital of Wenzhou Medical University from December 2017 to December 2021. BP levels 24 h after thrombolysis were analyzed to determine their association with clinical outcomes. BP parameters included mean BP, variability (standard deviation (SD)), and decreased magnitudes. The primary outcome was the 90-day modified Rankin Scale (mRS) scores.

Results

Higher mean systolic BP (SBP) was associated with poorer outcomes, with adjusted odds ratios (aORs) of 1.25 (95% CI, 1.03–1.51), 1.23 (1.01–1.49), and 1.25 (1.02–1.52) per 10 mmHg increase within 0–2 h, 2–6 h, and 6–24 h post-thrombolysis, respectively, but not for BP variability and decrease magnitudes. Significant improvements in outcomes were observed when the mean SBP was maintained within the range of 120–140 mmHg during both the 0–2 and 2–6 h periods, with aORs of 0.12 (95% CI, 0.02–0.75) and 0.19 (0.04–0.82), respectively. Larger decreases in SBP within 6 h post-thrombolysis were associated with a lower risk of intracerebral hemorrhage. These findings were consistent across subgroups and sensitivity analyses.

Conclusions

Achieving sustained low SBP levels (120–140 mmHg within the first 6 h) over 24 h is linked to better outcomes in thrombolyzed AIS patients.