HealthDay News — Stroke patients who receive intensive blood pressure lowering are less likely to suffer brain bleeds when treated with clot-busting therapies, according to a study published online February 7 in The Lancet to coincide with the American Stroke Association International Stroke Conference, held from February 6 to 8 in Honolulu.
Craig S. Anderson, PhD, from the University of New South Wales in Sydney, and colleagues randomly assigned (1:1) thrombolysis-eligible adults with acute ischemic stroke and systolic blood pressure ≥150mmHg within 6 hours of stroke onset to receive either intensive (target systolic blood pressure 130 to 140mmHg within 1 hour; 1081 patients) or guideline (target systolic blood pressure <180mmHg; 1115 patients) blood pressure-lowering treatment for 72 hours. Random assignment occurred between March 3, 2012, and April 30, 2018, at 110 sites in 15 countries.
The researchers found that 67.4% of the 2175 patients given intravenous alteplase were administered a standard dose. Over 24 hours, mean systolic blood pressure was 144.3mmHg in the intensive group and 149.8mmHg in the guideline group (P<.0001). At 90 days, functional status did not differ between groups (odds ratio, 1.01; 95% confidence interval, 0.87 to 1.17; P=.8702). Compared with the guideline group, fewer patients in the intensive group had any intracranial hemorrhage (odds ratio, 0.75; 95% confidence interval, 0.60 to 0.94; P=.0137). There were no significant differences between the groups in the number of patients with any serious adverse events (odds ratio, 0.86; 95% confidence interval, 0.70 to 1.05; P=.1412).
“These results might not support a major shift towards this treatment being applied in those receiving alteplase for mild-to-moderate acute ischemic stroke,” the authors write.
Several authors disclosed financial ties to pharmaceutical companies, including Takeda, which partially funded the study.
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