- Title
- Interaction of blood pressure lowering and alteplase dose in acute ischemic stroke: results of the Enhanced Control of Hypertension and Thrombolysis Stroke Study
- Creator
- Wang, Xia; Song, Lili; Arima, Hisatomi; Chalmers, John; Kim, Jong S.; Sharma, Vijay; Wang, Ji-Guang; Pontes-Neto, Octávio; Lavados, Pablo M.; Olavarría, Verónica V.; Lee, Tsong-Hai; Levi, Christopher; Yang, Jie; Martins, Sheila O.; Thang, Nguyen H.; Anderson, Craig S.; Sun, Lingli; Moullaali, Tom J.; Sandset, Else Charlotte; Delcourt, Candice; Lindley, Richard I.; Robinson, Thompson G.; Minhas, Jatinder S.
- Relation
- NHMRC.1020462 http://purl.org/au-research/grants/nhmrc/1020462 & NHMRC.1101113 http://purl.org/au-research/grants/nhmrc/1101113
- Relation
- Cerebrovascular Diseases Vol. 48, Issue 3-6, p. 207-216
- Publisher Link
- http://dx.doi.org/10.1159/000504745
- Publisher
- Karger
- Resource Type
- journal article
- Date
- 2019
- Description
- Objective: To determine the extent to which the effects of intensive blood pressure (BP) lowering are modified by doses of alteplase in thrombolysis-eligible acute ischemic stroke (AIS) patients. Methods: Prespecified analyses of the Enhanced Control of Hypertension and Thrombolysis Stroke Study for patients enrolled in both arms: (i) low-dose (0.6 mg/kg body weight) or standard-dose (0.9 mg/kg) alteplase and (ii) intensive (target systolic BP [SBP] 130-140 mm Hg) or guideline-recommended (target SBP <180 mm Hg) BP management. The primary outcome was functional recovery, measured by a shift in scores on modified Rankin scale at 90 days. The safety outcome was any intracranial hemorrhage (ICH). Results: There were 925 participants (mean age 67 years, 39% female, 77% Asian) randomized to both arms: 242 randomly assigned to guideline/standard-dose (GS); 234 to guideline/low-dose (GL); 227 to intensive/standard-dose (IS); and 222 to intensive/low-dose (IL). Overall, average SBP levels within 24 h were lower in the low-dose compared to standard-dose alteplase group (146 and 144 vs. 151 and 150 mm Hg, for GS and GL vs. IS and IL, respectively, p < 0.0001). There was no heterogeneity of the effects of BP lowering (intensive vs. guideline) on functional recovery between standard-dose (OR 0.81, 95% CI 0.59-1.12) and low-dose alteplase (1.06, 0.77-1.47; p = 0.25 for interaction). Similar results were observed for ICH (p = 0.50 for interaction). Conclusions: In thrombolysis-treated patients with predominantly mild-to-moderate severity AIS, intensive BP lowering neither improve functional recovery, either with low-or standard-dose intravenous alteplase, nor beneficially interact with low-dose alteplase in reducing ICH. Trial Registration: The trial is registered with ClinicalTrials.gov (NCT01422616).
- Subject
- acute ischemic stroke; thrombolysis; intracerebral hemorrhage; blood pressure lowering; hypertension; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1463111
- Identifier
- uon:46642
- Identifier
- ISSN:1015-9770
- Language
- eng
- Reviewed
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