Frequency of Increased Blood Pressure Levels During Systemic Thrombolysis and Risk of Intracerebral Hemorrhage

Background and Purpose-Significantly increased blood pressure (BP) is common in patients receiving intravenous thrombolysis (IVT). We aimed to investigate frequency of pre- and post-treatment elevated BP and its relation to intracerebral hemorrhage (ICH) and symptomatic ICH (sICH), respectively. Methods-Data for patients treated with intravenous thrombolysis in the years 2007 to 2009 were retrospectively extracted from our prospectively conducted local stroke database. All documented BP levels from admission to follow-up imaging scan were analyzed. BP protocol violations were defined as systolic BP > 185mm Hg and/or diastolic BP > 110 mm Hg. sICH was defined as ICH plus worsening of the National Institute of Health Stroke Scale >= 4 points. Results-BP protocol violation before IVT emerged in 12.6% and during the course of IVT in 40.1% of 427 patients. sICH occurred in 10 (2.3%) and ICH in general occurred in 51 (11.9%) of 427 patients. Proportions of BP protocol violations were similar in patients without ICH, with any ICH, and with sICH (3.1% versus 2.8% versus 3.2%). Systolic BP levels and mean arterial pressure did not differ between patients without ICH, patients with any ICH, and patients with sICH. In the multivariate analysis, only early CT findings independently predicted ICH (OR, 2.39; 95% CI, 1.25-4.61; P = 0.009). Conclusions-BP protocol violations are common before and during the course of IVT, but neither the frequency of BP protocol violations nor the BP levels predicted ICH or sICH in univariate or multivariate analyses. (Stroke. 2011; 42: 1702-1706.)