What is the optimal blood pressure target for thrombolysis patients?


Systolic blood pressure (BP) of more than 185 mm Hg is a contraindication to thrombolytic treatment in acute ischemic stroke (AIS) patients, but optimal post-thrombolysis target BP range is unknown. Recently, analysis of the BP control arm of the ENCHANTED randomized clinical trial was published: AIS patients with systolic blood pressure >150 mm Hg were randomized within 6 h of stroke onset to receive intensive (target systolic BP 130–140 mm Hg within 1h) or guideline (target systolic BP <180 mm Hg) BP-lowering treatment over 72h. Functional status at 90 days was measured as primary outcome. 2196 alteplase-eligible AIS patients were included: Mean systolic BP over 24h was 144.3 mm Hg (intensive group) and 149.8 mm Hg (guideline group) (p<0·0001). Functional status at 90 days did not differ for both cohorts. A significant difference in incidence of intracranial hemorrhages was observed: 14.8% in the intensive group versus 18.7% in the guidelines group (p=0.0137). The incidence of serious adverse events was similar for both groups. Although intensive BP lowering is safe, the observed reduction in intracranial hemorrhage did not lead to improved outcomes. Further research is required to define the optimal peri-BP target range for AIS patients.

Robert M. Starke, MD, MSC
Miami, FL