Correlation between blood pressure changes within 24 h after intravenous thrombolysis and the outcome in patients with acute ischemic stroke / 国际脑血管病杂志

ABSTRACT

Objective:To investigate the correlation between blood pressure changes within 24 h after intravenous thrombolysis and the outcome in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke treated with alteplase intravenous thrombolysis in the Department of Neurology, Anhui No. 2 Provincial People's Hospital from June 2018 to September 2020 were enrolled retrospectively. The patients who received antihypertensive therapy before and within 24 h after intravenous thrombolysis were excluded. The blood pressure before intravenous thrombolysis and the blood pressure drop within 24 h after intravenous thrombolysis were recorded. The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after the onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to investigate the independent correlation between blood pressure changes within 24 h after intravenous thrombolysis and the clinical outcomes. Results:A total of 205 patients with acute ischemic stroke were enrolled, including 125 males (60.98%), 80 females (39.02%); aged 63.30±9.63 years; 124 (60.49%) had a good outcome, and 81 (39.51%) had a poor outcome. Univariate analysis showed that the proportion of diabetic patients as well as baseline systolic blood pressure, prethrombolytic blood glucose, baseline National Institutes of Health Stroke Scale score, and the incidence of symptomatic intracranial hemorrhage in the good outcome group were significantly lower than those in the poor outcome group, and the proportion of patients with small vessel occlusion and the decrease in systolic blood pressure within 24 h after thrombolytic therapy were significantly higher than those in the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that higher baseline systolic blood pressure was independently associated with the poor outcome at 90 d after intravenous thrombolysis (odds ratio 0.964, 95% confidence interval 0.942-0.987; P=0.002), and a greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was independently associated with a good outcome (odds ratio 1.134, 95% confidence interval 1.067-1.206; P<0.001). Conclusion:For patients with acute ischemic stroke who received intravenous thrombolysis, higher baseline blood pressure before intravenous thrombolysis was associated with the poor outcome, and greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was associated with the good outcome.