title: Response of blood pressure and blood glucose to treatment with recombinant tissue-type plasminogen activator in acute ischemic stroke: evidence from the virtual international stroke trials archive.
abstract: OBJECTIVE
  Elevations in blood pressure (BP) and blood glucose are common during stroke and may represent a stress response secondary to the acute neurological deficit. If so, they should settle more completely in recombinant tissue-type plasminogen activator (rtPA)-treated patients in association with improved neurological status.
  
  
  METHODS
  We performed a controlled comparison of 24-hour declines in BP and glucose in rtPA-treated and control patients from the Virtual Stroke International Stroke Trial Archive (VISTA) database. Twenty-four-hour falls in BP and glucose were compared using multiple regression to account for baseline imbalances. The logarithmic transformation of glucose was used and 24-hour differences expressed as ratios of 24 hours to admission geometric means. Two-way analysis of variance was used to test for interaction between rtPA and early improvement for 24-hour falls in BP and blood glucose.
  
  
  RESULTS
  BP analysis included 5406 patients (rtPA=41%) and glucose analysis 4288 (rtPA=37%). rtPA-treated patients were younger, less likely to have a history of hypertension or diabetes, and had more severe strokes on admission. BP and glucose were lower at baseline in rtPA-treated patients than control subjects. On regression, rtPA predicted significantly greater 24-hour falls in systolic BP (β=3.9; 95% CI, 2.8-5.0), diastolic BP (β=3.1; 95% CI, 2.4-3.9), and glucose (β=0.97; 95% CI, 0.95-0.99). rtPA did not interact with early neurological improvement for 24-hour falls in systolic BP (P=0.72), diastolic BP (P=0.79), or blood glucose (P=0.51).
  
  
  CONCLUSIONS
  A stress response does not appear to be the principal cause of elevations in BP and glucose during stroke.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Western Infirmary, Glasgow, UK.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Kerr
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Fulton
authors.forename: Peter
authors.initials: P
authors.lastname: Higgins
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.forename: Patrick
authors.initials: P
authors.lastname: Lyden
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects*; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012044:Regression Analysis; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014584:User-Computer Interface
chemical_list: D001786:Blood Glucose; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator