title: Aggressive blood pressure-lowering treatment before intravenous tissue plasminogen activator therapy in acute ischemic stroke.
abstract: BACKGROUND
  Patients with acute ischemic stroke (AIS) commonly have elevated blood pressure (BP). Guidelines have recommended against treatment with intravenous tissue plasminogen activator (tPA) when aggressive measures such as continuous infusion with nicardipine hydrochloride are required to maintain BP lower than 185/110 mm Hg. We evaluated the effect of elevated BP and its management on clinical outcomes after tPA therapy in AIS.
  
  
  OBJECTIVE
  To evaluate safety and outcome in patients with AIS who require treatment to lower BP before tPA therapy and to compare safety and outcome in patients who received aggressive treatment with nicardipine with those who received labetalol hydrochloride before tPA.
  
  
  METHODS
  Retrospective review of medical records for all patients who received intravenous tPA within 3 hours of AIS onset.
  
  
  METHODS
  Emergency department. Patients One hundred seventy-eight patients with AIS treated with tPA.
  
  
  METHODS
  Occurrence of symptomatic intracerebral hemorrhage and neurologic deterioration.
  
  
  RESULTS
  Fifty patients required BP lowering before tPA therapy. Twenty-four of these patients (48%) received nicardipine either after labetalol or as first-line therapy. Patients requiring antihypertensive agents had higher baseline blood glucose concentrations, incidence of hypertension, and National Institutes of Health Stroke Scale scores. The rate of adverse events and of modified Rankin score at discharge were not significantly different in patients without BP-lowering treatment compared with patients given either labetalol or nicardipine before intravenous tPA therapy.
  
  
  CONCLUSIONS
  Blood pressure lowering before intravenous tPA therapy, even using aggressive measures, may not be associated with a higher rate of hemorrhage or poor outcome. Data suggest that patients with AIS requiring aggressive treatment to lower BP should not be excluded from receiving tPA therapy. A prospective study is needed to support these conclusions.
authors.affiliation: Vascular Neurology Program, Department of Neurology, University of Texas Health Science Center at Houston, 6431 Fannin St, Medical School Bldg Room 7.128, Houston, TX 77030, USA. Sherylmartinschild@yahoo.com
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.forename: Hen
authors.initials: H
authors.lastname: Hallevi
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.forename: Aslam M
authors.initials: AM
authors.lastname: Khaja
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Barreto
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Gonzales
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000959:Antihypertensive Agents; D010959:Tissue Plasminogen Activator
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