Introduction

Acute management of blood pressure in ischemic stroke treated with reperfusion therapy remains uncertain. We evaluated blood pressures during the first 24-hours after reperfusion therapy in relation to in-hospital outcomes.

Methods

We conducted a single-center retrospective study of blood pressure in the first 24 hours among ischemic stroke patients who underwent reperfusion therapy with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) at a tertiary referral center. Blood pressure variability was expressed as the range between the highest and the lowest pressures. Outcomes of interest were discharge disposition and in-hospital mortality. Favorable outcome was defined as a discharge destination to home or inpatient rehabilitation facility (IRF). Multivariable logistic regression analysis was performed with adjustment for age, National Institutes of Health Stroke Scale score, and patients receiving reperfusion therapy.

Results

Among the 140 ischemic stroke patients (117 IVT, 84 MT and 61 both), 95 (67.8%) had favorable discharge disposition and 24 (17.1%) died. Higher 24-hour peak systolic blood pressures (SBPs) and peak mean arterial pressures (MAPs) were independently associated with a lower likelihood of favorable discharge disposition, with an adjusted odds ratio (aOR) 0.868, 95 % CI 0.760 - 0.990 per 10 mm Hg for SBP and aOR 0.710, 95% CI 0.515 - 0.980 for MAP, and with increased odds of death aOR 1.244, 95% CI 1.056-1.467 and aOR 1.760, 95% CI 1.119 - 2.769 respectively. Greater variability of SBP and MAP was also associated with odds of death aOR 1.327, 95% CI 1.104 - 1.595 and aOR 1.577, 95% CI 1.060- 2.345 respectively, without a significant effect on discharge disposition.

Conclusion

In the first 24 hours after reperfusion therapy, higher peak and variable blood pressures are associated with unfavorable discharge outcomes and increased in-hospital mortality. Further studies in stroke patients undergoing reperfusion therapy might target blood pressure reduction and variability to improve patient outcomes.

中文翻译：

---

接受缺血再灌注治疗的急性缺血性卒中患者的血压和出院结果

介绍

用再灌注疗法治疗的缺血性中风的急性血压管理仍不确定。我们评估了再灌注治疗后头24小时的血压与院内预后的关系。

方法

我们对在三级转诊中心接受了静脉溶栓（IVT）或机械血栓切除术（MT）的再灌注治疗的缺血性卒中患者的前24小时内血压进行了单中心回顾性研究。血压变异性表示为最高压力与最低压力之间的范围。感兴趣的结果是出院情况和院内死亡率。良好的结局定义为出院或住院康复设施（IRF）的出院目的地。对年龄，美国国立卫生研究院卒中量表评分和接受再灌注治疗的患者进行调整后，进行多变量logistic回归分析。

结果

140例缺血性中风患者（117例IVT，84例MT和61例两者）中，有95例（67.8％）的出院情况良好，有24例（17.1％）死亡。24小时的最高收缩压峰值（SBP）和峰值平均动脉压（MAPs）分别与较低的有利排出物处置可能性相关，调整后的优势比（aOR）为0.868，95％CI 0.760-0.990 / 10/10 mm对于SBP和aOR 0.710为Hg，对于MAP为95％CI 0.515-0.980，并且死亡几率分别为aOR 1.244、95％CI 1.056-1.467和aOR 1.760、95％CI 1.119-2.769。SBP和MAP的更大变异性也分别与死亡几率aOR 1.327、95％CI 1.104-1.595和aOR 1.577、95％CI 1.060-2.345无关，对出院处置没有显着影响。

结论

在再灌注治疗后的最初24小时内，较高的峰值血压和变化的血压与不良的出院结果和院内死亡率增加相关。对接受再灌注治疗的中风患者的进一步研究可能针对降低血压和降低血压变化以改善患者预后。