From the Department of Neurology (M.D., D.W.J.D.), Erasmus University Medical Center, Rotterdam; Department of Neurology (M.D.), University Medical Center Utrecht; Department of Neurology (T.P.Z., P.J.N., D.v.d.B.), Academic Medical Centre Amsterdam; Department of Neurology (R.J.v.O.), Maastricht University Medical Center; Department of Neurology (N.D.K.), Leiden University Medical Center, the Netherlands.
Neurology. 2015 Apr 7;84(14):1419-25. doi: 10.1212/WNL.0000000000001445. Epub 2015 Mar 6.
We investigated whether an active blood pressure-lowering strategy is associated with more patients receiving thrombolytics compared with a conservative "watch and measure" strategy, and assessed safety and functional outcome of these 2 treatment strategies.
This is a post hoc analysis in 2 randomized controlled stroke trials, the PRACTISE (Promoting Acute Thrombolysis in Ischemic Stroke) and the PASS (Preventive Antibiotics in Stroke Study). We included all patients with elevated pretreatment blood pressure above 185/110 mm Hg at presentation but otherwise eligible for IV thrombolysis (IVT). The decision to use an active or conservative strategy was in accordance with local hospital treatment guidelines. The primary outcome was the proportion of patients treated with IVT. Secondary outcomes were (1) symptomatic intracranial hemorrhage (increased neurologic deficit with a concomitant hemorrhage on neuroimaging), (2) functional outcome at 3 months, and (3) the door-to-needle time.
We included 224 patients, 66 (29%) received the active and 158 (71%) the conservative strategy. In the active group, 55 patients (83%) received thrombolytics vs 87 (55%) in the conservative group, an increase of 28% (95% confidence interval: 16%-40%). If only patients actually treated with IVT were considered, the rate of symptomatic intracranial hemorrhage was 7% in both groups. There was no difference in door-to-needle time.
Active blood pressure lowering was associated with an increased proportion of patients treated with IVT compared with a conservative strategy, without a difference in symptomatic hemorrhage rate.
我们研究了与保守的“观察和测量”策略相比，积极降压策略是否会使更多患者接受溶栓治疗，并评估这两种治疗策略的安全性和功能结局。
这是 2 项随机对照卒中试验（PRACTISE[促进缺血性卒中溶栓]和 PASS[卒中预防抗生素研究]）的事后分析。我们纳入了所有在就诊时血压升高至 185/110mmHg 以上但仍符合 IV 溶栓治疗（IVT）条件的患者。采用积极或保守策略的决策符合当地医院治疗指南。主要结局是接受 IVT 治疗的患者比例。次要结局为（1）症状性颅内出血（神经影像学检查显示神经功能缺损加重同时伴有出血），（2）3 个月时的功能结局，以及（3）门到针时间。
我们纳入了 224 例患者，66 例（29%）接受了积极治疗，158 例（71%）接受了保守治疗。在积极治疗组中，55 例（83%）患者接受了溶栓治疗，而在保守治疗组中，87 例（55%）患者接受了溶栓治疗，增加了 28%（95%置信区间：16%-40%）。如果仅考虑实际接受 IVT 的患者，两组的症状性颅内出血发生率均为 7%。两组的门到针时间无差异。
与保守策略相比，积极降压与接受 IVT 治疗的患者比例增加相关，且症状性出血率无差异。
