ASA: Intensive BP Control Lowers Bleeding Risk in Stroke Patients

TUESDAY, Feb. 12, 2019 — Stroke patients who receive intensive blood pressure lowering are less likely to suffer brain bleeds when treated with clot-busting therapies, according to a study published online Feb. 7 in The Lancet to coincide with the American Stroke Association International Stroke Conference, held from Feb. 6 to 8 in Honolulu.

Craig S. Anderson, Ph.D., from the University of New South Wales in Sydney, and colleagues randomly assigned (1:1) thrombolysis-eligible adults with acute ischemic stroke and systolic blood pressure ≥150 mm Hg within six hours of stroke onset to receive either intensive (target systolic blood pressure 130 to 140 mm Hg within one hour; 1,081 patients) or guideline (target systolic blood pressure <180 mm Hg; 1,115 patients) blood pressure-lowering treatment for 72 hours. Random assignment occurred between March 3, 2012, and April 30, 2018, at 110 sites in 15 countries.

The researchers found that 67.4 percent of the 2,175 patients given intravenous alteplase were administered a standard dose. Over 24 hours, mean systolic blood pressure was 144.3 mm Hg in the intensive group and 149.8 mm Hg in the guideline group (P < 0.0001). At 90 days, functional status did not differ between groups (odds ratio, 1.01; 95 percent confidence interval, 0.87 to 1.17; P = 0.8702). Compared with the guideline group, fewer patients in the intensive group had any intracranial hemorrhage (odds ratio, 0.75; 95 percent confidence interval, 0.60 to 0.94; P = 0.0137). There were no significant differences between the groups in the number of patients with any serious adverse events (odds ratio, 0.86; 95 percent confidence interval, 0.70 to 1.05; P = 0.1412).

“These results might not support a major shift towards this treatment being applied in those receiving alteplase for mild-to-moderate acute ischemic stroke,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Takeda, which partially funded the study.

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Posted: February 2019

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