013 The impact of aggressive blood pressure management in the post-thrombolysis setting. (29th July 2019)

• Record Type: Journal Article
• Authors: Harper, Bethan; McNaughton, Harry; Ranta, Anna
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 90(2019)e7
• Page Start: A5
• Page End: A5
• Publication Date: 2019-07-29
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2019-anzan.13
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Introduction: High blood pressure (BP) post-thrombolysis has been associated with an increased rate of bleeding and poorer outcome. We noted frequent BPs of >180 mmHg with a target of keeping BP <180. We tested whether a more aggressive target of SBP <160 mmHg would result in fewer BP protocol violations. Methods: Patients were prospectively captured comparing patients thrombolysed during the 12 months before and 12 months following the introduction of a new more aggressive BP protocol, allowing for a 6 month transition period. Results were adjusted for baseline function and stroke severity using regression analysis. Results: Pre-protocol change 68 and post- 100 patients were thrombolysed. Baseline characteristics were similar between groups. There was a trend for a lower rate of SBPs >180 mmHg (adjusted OR 0.49; 95% CI 0.31–1.1; p=0.097) and a significantly higher rate of SBPs <120 mmHg (adjusted OR 3.06; 95% CI 1.52–6.17; p=0.002) in the aggressive BP protocol group; although events of extreme SBPs (>200 and <100 mmHg) were similar between groups. Favourable outcomes (mRS = 0–2) at 3 months were similar between groups (adjusted OR 1.27; 95% CI 0.58–2.8; p=0.56) as was the rate of symptomatic haemorrhages (adjusted OR 1.26; 95% CI 0.28–5.7; p=0.76). Model fit was improved by adding study group to the model. Conclusions: More aggressive post-thrombolysis BP management lowered the overall BP, but did not result in improved patient outcomes. Potential explanations include a small sample size, reduced cerebral perfusion off-setting reduced bleeding risk, or high BP being merely an epiphenomenon of worse outcome rather than causative.