Association of Elevated Blood Pressure Levels with Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis
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Background and Purpose Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes. Methods Eligible studies involving IVT-treated AIS patients were identified that reported the association of mean systolic BP (SBP) or diastolic BP levels before and after IVT with the following outcomes: 3-month favorable functional outcome (modified Rankin Scale [mRS] scores of 0–1) and 3-month functional independence (mRS scores of 0–2), 3-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed using random-effects models. Results We identified 26 studies comprising 56,513 patients. Higher pre- (P=0.02) and posttreatment (P=0.006) SBP levels were observed in patients with sICH. Patients with 3-month functional independence had lower post-treatment (P<0.001) SBP whereas trended towards lower pre-treatment (P=0.06) SBP. In adjusted analyses, elevated pre- (ORadj, 1.08; 95% confidence interval [CI], 1.01 to 1.16) and post-treatment (ORadj, 1.13; 95% CI, 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj, 0.91; 95% CI, 0.84 to 0.98) and post-treatment (ORadj, 0.70; 95% CI, 0.57 to 0.87) SBP values were also related to lower odds of 3-month functional independence. Conclusions We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data on the aforementioned association.
Abstract
Background and Purpose Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes. Methods Eligible studies involving IVT-treated AIS patients were identified that reported the association of mean systolic BP (SBP) or diastolic BP levels before and after IVT with the following outcomes: 3-month favorable functional outcome (modified Rankin Scale [mRS] scores of 0–1) and 3-month functional independence (mRS scores of 0–2), 3-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed using random-effects models. Results We identified 26 studies comprising 56,513 patients. Higher pre- (P=0.02) and posttreatment (P=0.006) SBP levels were observed in patients with sICH. Patients with 3-month functional independence had lower post-treatment (P<0.001) SBP whereas trended towards lower pre-treatment (P=0.06) SBP. In adjusted analyses, elevated pre- (ORadj, 1.08; 95% confidence interval [CI], 1.01 to 1.16) and post-treatment (ORadj, 1.13; 95% CI, 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj, 0.91; 95% CI, 0.84 to 0.98) and post-treatment (ORadj, 0.70; 95% CI, 0.57 to 0.87) SBP values were also related to lower odds of 3-month functional independence. Conclusions We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data on the aforementioned association.
참고문헌 (54)
- Hacke W, "Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke", N Engl J Med, 359, pp.1317~1329 (2008)
- National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, "Tissue plasminogen activator for acute ischemic stroke", N Engl J Med, 333, pp.1581~1587 (1995)
- Tsivgoulis G, "Intravenous thrombolysis for acute ischaemic stroke: effective blood pressure control matters", Int J Stroke, 6, pp.125~127 (2011)
- Powers WJ, "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2018, pp.49, e46~e110
- Lopez-Yunez AM, "Protocol violations in community-based rTPA stroke treatment are associated with symptomatic intracerebral hemorrhage", Stroke, 32, pp.12~16 (2001)
- Tsivgoulis G, "Pre-tissue plasminogen activator blood pressure levels and risk of symptomatic intracerebral hemorrhage", Stroke, 40, pp.3631~3634 (2009)
- Tsivgoulis G, "Association of pretreatment blood pressure with tissue plasminogen activator-induced arterial recanalization in acute ischemic stroke", Stroke, 38, pp.961~966 (2007)
- Wahlgren N, "Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST)", Stroke, 39, pp.3316~3322 (2008)
- Oliveira-Filho J, "Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset", Neurology, 61, pp.1047~1051 (2003)
- Castillo J, "Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome", Stroke, 35, pp.520~526 (2004)
- Liberati A, "The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration", J Clin Epidemiol, 62, pp.e1~e34 (2009)
- "Transparency and openness promotion (TOP) guidelines for authors publishing in an American Heart Association Journal"[URL]
- Katsanos AH, "Heart failure and the risk of ischemic stroke recurrence: a systematic review and meta-analysis", J Neurol Sci, 362, pp.182~187 (2016)
- Deeks JJ, "Cochrane Handbook for Systematic Reviews of Interventions" (2011), Cochrane Collaboration
- DerSimonian R, "Meta-analysis in clinical trials", Control Clin Trials, 7, pp.177~188 (1986)
- Cohen J, "Statistical Power Analysis for the Behavioral Sciences" (1988), Lawrence Erlbaum Associates
- Szumilas M, "Explaining odds ratios", J Can Acad Child Adolesc Psychiatry, 19, pp.227~229 (2010)
- IntHout J, "The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method", BMC Med Res, 14, pp.25~ (2014)
- Sterne JA, "Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomized controlled trials", BMJ, 343, pp.d4002~ (2011)
- Duval S, "A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis", J Am Stat Assoc, 95, pp.89~98 (2000)
- Wallace BC, "Closing the gap between methodologists and end-users: R as a computational back-end", J Stat Softw, 49, pp.1~15 (2012)
- Ahmed N, "Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR)", Stroke, 40, pp.2442~2449 (2009)
- Delgado-Mederos R, "Prognostic significance of blood pressure variability after thrombolysis in acute stroke", Neurology, 71, pp.552~558 (2008)
- Endo K, "Impact of early blood pressure variability on stroke outcomes after thrombolysis: the SAMURAI rt-PA Registry", Stroke, 44, pp.816~818 (2013)
- Huang YH, "Factors influencing clinical outcomes of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator", Chin Med J, 126, pp.4685~4690 (2013)
- Idicula TT, "The effect of physiologic derangement in patients with stroke treated with thrombolysis", J Stroke Cerebrovasc Dis, 17, pp.141~146 (2008)
- Kellert L, "Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome", Cerebrovasc Dis, 33, pp.135~140 (2012)
- Kellert L, "Reciprocal interaction of 24-hour blood pressure variability and systolic blood pressure on outcome in stroke thrombolysis", Stroke, 48, pp.1827~1834 (2017)
- Lindsberg PJ, "Community-based thrombolytic therapy of acute ischemic stroke in Helsinki", Stroke, 34, pp.1443~1449 (2003)
- Liu K, "Systolic blood pressure variability is associated with severe hemorrhagic transformation in the early stage after thrombolysis", Transl Stroke Res, 7, pp.186~191 (2016)
- Martins AI, "Recanalization modulates association between blood pressure and functional outcome in acute ischemic stroke", Stroke, 47, pp.1571~1576 (2016)
- Menon BK, "Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator", Stroke, 43, pp.2293~2299 (2012)
- Molina CA, "Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator", Stroke, 35, pp.151~156 (2004)
- Molina CA, "Transcranial ultrasound in clinical sonothrombolysis (TUCSON) trial", Ann Neurol, 66, pp.28~38 (2009)
- Rusanen H, "The association of blood pressure and collateral circulation in hyperacute ischemic stroke patients treated with intravenous thrombolysis", Cerebrovasc Dis, 39, pp.130~137 (2015)
- Saqqur M, "Symptomatic intracerebral hemorrhage and recanalization after IV rt-PA: a multicenter study", Neurology, 71, pp.1304~1312 (2008)
- Tomii Y, "Effects of hyperacute blood pressure and heart rate on stroke outcomes after intravenous tissue plasminogen activator", J Hypertens, 29, pp.1980~1987 (2011)
- Toni D, "Intravenous thrombolysis in young stroke patients: results from the SITS-ISTR", Neurology, 78, pp.880~887 (2012)
- Waltimo T, "Post-thrombolytic blood pressure and symptomatic intracerebral hemorrhage", Eur J Neurol, 23, pp.1757~1762 (2016)
- Wu L, "Relationship between post-thrombolysis blood pressure and outcome in acute ischemic stroke patients undergoing thrombolysis therapy", J Stroke Cerebrovasc Dis, 26, pp.2279~2286 (2017)
- Wu W, "Relationship between blood pressure and outcomes in acute ischemic stroke patients administered lytic medication in the TIMS-China Study", PLoS One, 11, pp.e0144260~ (2016)
- Yan S, "“Sudden drop” in blood pressure is associated with recanalization after thrombolysis", Medicine, 94, pp.e1132~ (2015)
- Yong M, "Characteristics of blood pressure profiles as predictors of long-term outcome after acute ischemic stroke", Stroke, 36, pp.2619~2625 (2005)
- Yong M, "Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial", Stroke, 39, pp.366~372 (2008)
- Nogueira RG, "Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) and Multi MERCI Trials", Stroke, 40, pp.3777~3783 (2009)
- Vemmos KN, "Association between 24-h blood pressure monitoring variables and brain oedema in patients with hyperacute stroke", J Hypertens, 21, pp.2167~2173 (2003)
- Ntaios G, "Blood pressure changes in acute ischemic stroke and outcome with respect to stroke etiology", Neurology, 79, pp.1440~1448 (2012)
- Leonardi-Bee J, "Blood pressure and clinical outcomes in the International Stroke Trial", Stroke, 33, pp.1315~1320 (2002)
- Chamorro A, "Catecholamines, infection, and death in acute ischemic stroke", J Neurol Sci, 252, pp.29~35 (2007)
- Mistry EA, "Systolic blood pressure within 24 hours after thrombectomy for acute ischemic stroke correlates with outcome", J Am Heart Assoc, 6, pp.e006167~ (2017)
- Sandset EC, "The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebocontrolled, double-blind trial", Lancet, 377, pp.741~750 (2011)
- ENOS Trial Investigators, "Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial", Lancet, 385, pp.617~628 (2015)
- Huang Y, "Rationale, design, and progress of the ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED) trial: an international multicenter 2×2 quasi-factorial randomized controlled trial of low- vs. standard-dose rt-PA and early intensive vs. guideline-recommended blood pressure lowering in patients with acute ischaemic stroke eligible for thrombolysis treatment", Int J Stroke, 10, pp.778~788 (2015)
- Kirkham JJ, "The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews", BMJ, 340, pp.c365~ (2010)