Arterial pressure during first day after intravenous thrombolysis and acute ischemic stroke outcomes: single-center randomized controlled study

Introduction. Blood pressure optimization during and after reperfusion in patients with acute ischemic stroke can reduce the risk of hemorrhagic complications and improve functional recovery. Several randomized controlled trials of different target blood pressure values have been published with varying results.

The objective was to evaluate the effect of intensive hypotensive therapy in the first day after intravenous thrombolysis on outcomes of acute ischemic stroke and incidence of complications.

Materials and methods. A single-center open label randomized controlled trial was conducted. Patients older than 18 years with acute ischemic stroke who underwent reperfusion were included. Patients were randomized into 2 groups: with a target systolic blood pressure of 161–185 mm Hg on the first day (control group) versus < 160 mm Hg (intensive hypotensive therapy group). The primary end points were mortality and modified Rankin Scale score at day 90 from the onset of stroke.

Results. The final analysis included 69 patients. In the intensive hypotensive therapy group, mortality rate did not differ from the control group: OR 1.1 [95% CI 0.3 to 4.8] (p = 0.896). The median modified Rankin scale score at day 90 in the control group was 2 (1; 3.8) versus 2 (1; 3.5) in the intensive hypotensive therapy group (p = 0.812).

Conclusion. Intensive hypotensive therapy at the first day after intravenous thrombolysis in acute ischemic stroke patients with target values of systolic blood pressure < 160 mm Hg compared to conventional values of 161–185 mm Hg neither improved functional outcome nor decreased mortality and complications rate on day 90 from the onset of stroke.

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