Interaction of Blood Pressure Lowering and Alteplase Dose in Acute Ischemic Stroke: Results of the Enhanced Control of Hypertension and Thrombolysis Stroke Study

Xia Wang, Lili Song, Jie Yang, Lingli Sun, Tom J. Moullaali, Else Charlotte Sandset, Candice Delcourt, Richard I. Lindley, Thompson G. Robinson, Jatinder S. Minhas, Hisatomi Arima, John Chalmers, Jong S. Kim, Vijay Sharma, Ji Guang Wang, Octávio Pontes-Neto, Pablo M. Lavados, Verónica V. Olavarriá, Tsong Hai Lee, Christopher LeviSheila O. Martins, Nguyen H. Thang, Craig S. Anderson, Enchanted Investigators

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)207-216
Number of pages10
JournalCerebrovascular Diseases
Volume48
Issue number3-6
DOIs
Publication statusPublished - Jan 2020
Externally publishedYes

Keywords

  • Acute ischemic stroke
  • Blood pressure lowering
  • Hypertension
  • Intracerebral hemorrhage
  • Thrombolysis

Fingerprint

Dive into the research topics of 'Interaction of Blood Pressure Lowering and Alteplase Dose in Acute Ischemic Stroke: Results of the Enhanced Control of Hypertension and Thrombolysis Stroke Study'. Together they form a unique fingerprint.

Cite this