title: Outcomes of Patients Requiring Blood Pressure Control Before Thrombolysis with tPA for Acute Ischemic Stroke.
abstract: BACKGROUND
  The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis.
  
  
  METHODS
  We performed a retrospective review of patients treated with tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) between 2004-2011. We compared the outcomes of patients treated with tPA for AIS who required aggressive BP control prior to thrombolysis to those requiring standard or no BP control prior to thrombolysis. The primary outcome of interest was safety, defined by all grades of hemorrhagic transformation and neurologic deterioration. The secondary outcome was efficacy, determined by functional status at discharge, and in-hospital deaths.
  
  
  RESULTS
  Of 427 patients included in the analysis, 89 received aggressive BP control prior to thrombolysis, 65 received standard BP control, and 273 required no BP control prior to thrombolysis. Patients requiring BP control had more severe strokes, with median arrival National Institutes of Health Stroke Scale of 10 (IQR [6-17]) in patients not requiring BP control versus 11 (IQR [5-16]) and 13 (IQR [7-20]) in patients requiring standard and aggressive BP lowering therapies, respectively (p=0.048). In a multiple logistic regression model adjusting for baseline differences, there were no statistically significant differences in adverse events between the three groups (P>0.10).
  
  
  CONCLUSIONS
  We observed no association between BP control and adverse outcomes in ischemic stroke patients undergoing thrombolysis. However, additional study is necessary to confirm or refute the safety of aggressive BP control prior to thrombolysis.
authors.affiliation: University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Bryan
authors.initials: B
authors.lastname: Darger
authors.affiliation: University of Texas Health Science Center at Houston, Department of Neurology, Houston, Texas.
authors.forename: Nicole
authors.initials: N
authors.lastname: Gonzales
authors.affiliation: University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Rosa C
authors.initials: RC
authors.lastname: Banuelos
authors.affiliation: University of Texas Health Science Center at Houston, Department of Neurology, Houston, Texas.
authors.forename: Hui
authors.initials: H
authors.lastname: Peng
authors.affiliation: University of Texas Health Science Center at Houston, Department of Emergency Medicine, Houston, Texas.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Radecki
authors.affiliation: University of Texas Health Science Center at Houston, Department of Emergency Medicine, Houston, Texas.
authors.forename: Pratik B
authors.initials: PB
authors.lastname: Doshi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator