Volume 16, Issue 7, December 2015.
Bryan Darger, BA, et al.

Introduction: The purpose of this study was to assess safety and efficacy of thrombolysis in the
setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP
control prior to thrombolysis.
Methods: We performed a retrospective review of patients treated with tissue plasminogen activator
(tPA) for acute ischemic stroke (AIS) between 2004-2011. We compared the outcomes of patients
treated with tPA for AIS who required aggressive BP control prior to thrombolysis to those requiring
standard or no BP control prior to thrombolysis. The primary outcome of interest was safety, defined
by all grades of hemorrhagic transformation and neurologic deterioration. The secondary outcome
was efficacy, determined by functional status at discharge, and in-hospital deaths.
Results: Of 427 patients included in the analysis, 89 received aggressive BP control prior to
thrombolysis, 65 received standard BP control, and 273 required no BP control prior to thrombolysis.
Patients requiring BP control had more severe strokes, with median arrival National Institutes of
Health Stroke Scale of 10 (IQR [6-17]) in patients not requiring BP control versus 11 (IQR [5-16]) and
13 (IQR [7-20]) in patients requiring standard and aggressive BP lowering therapies, respectively
(p=0.048). In a multiple logistic regression model adjusting for baseline differences, there were no
statistically significant differences in adverse events between the three groups (P>0.10).
Conclusion: We observed no association between BP control and adverse outcomes in ischemic
stroke patients undergoing thrombolysis. However, additional study is necessary to confirm or refute
the safety of aggressive BP control prior to thrombolysis.