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Journal Articles European Stroke Journal Year : 2021

24-hour blood pressure variability and treatment effect of intravenous alteplase in acute ischaemic stroke

Ewgenia Barow
Florent Boutitie
  • Function : Author
Bastian Cheng
  • Function : Author
Tae-Hee Cho
  • Function : Author
Martin Ebinger
  • Function : Author
Matthias Endres
  • Function : Author
Jochen Fiebach
  • Function : Author
Jens Fiehler
  • Function : Author
Alina Nickel
  • Function : Author
Josep Puig
  • Function : Author
Robin Lemmens
  • Function : Author
Vincent Thijs
  • Function : Author
Keith Muir
  • Function : Author
Norbert Nighoghossian
  • Function : Author
Salvador Pedraza
  • Function : Author
Claus Simonsen
  • Function : Author
Christian Gerloff
  • Function : Author
Götz Thomalla
  • Function : Author

Abstract

Introduction To assess the association between 24 h blood pressure variability (BPV) on functional outcome and treatment effect of intravenous alteplase in acute ischaemic stroke. Patients and methods In all patients with acute ischaemic stroke of unknown onset randomised in the WAKE-UP (Efficacy and Safety of magnetic resonance imaging [MRI]-based Thrombolysis in Wake-Up Stroke) trial, blood pressure (BP) was measured before randomisation and after initiation of treatment at regular intervals up to 24 hours. Individual BPV was measured by coefficient of variation (CV) of all BP values. Primary outcome measure was favourable outcome defined by a modified Rankin Scale (mRS) score 0 or 1 at 90 days after stroke. Results BP measurements were available for 498 of 503 patients randomised (177 women [35.5%], mean age [SD] of 65.2 [11.5] years). Systolic BPV was not associated with the treatment effect of thrombolysis (test for interaction, p = 0.46). The adjusted odds ratio (aOR) for favourable outcome with alteplase, adjusted for age, stroke severity and baseline BP on admission, did not show an association across the quintiles of increasing systolic BPV with an aOR 1.89 (95% confidence interval [CI], 0.76–4.70) in the lowest quintile to aOR 1.05 (95% CI, 0.43–2.56) in the highest quintile. Higher mean systolic BP was associated with a smaller treatment effect of thrombolysis with a significant interaction (p = 0.033). The aOR for favourable outcome with alteplase decreased with quintiles of increasing mean systolic BP from aOR 3.16 (95% CI, 1.26–7.93) in the lowest quintile to aOR 0.84 (95% CI, 0.34–2.10) in in the highest quintile. Conclusions There was a significant interaction between mean systolic BP and treatment effect of thrombolysis with higher mean systolic BP being associated with poorer outcome. BPV was not associated with outcome after thrombolysis. ClinicalTrials.gov identifier NCT01525290.

Dates and versions

hal-04152399 , version 1 (05-07-2023)

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Ewgenia Barow, Florent Boutitie, Bastian Cheng, Tae-Hee Cho, Martin Ebinger, et al.. 24-hour blood pressure variability and treatment effect of intravenous alteplase in acute ischaemic stroke. European Stroke Journal, 2021, 6 (2), pp.168-175. ⟨10.1177/23969873211014758⟩. ⟨hal-04152399⟩

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