Association between blood pressure after thrombolysis and neurological outcome in the elderly patients with ischemic stroke

Background: This study aimed to evaluate the relationship between systolic blood pressures (SBPs) within 10 hours after intravenous recombinant tissue plasminogen activator (rtPA) treatment and early neurological outcomes in geriatric and nongeriatric patients with acute ischemic stroke (AIS). Methods: This was a retrospective observational study of patients with AIS who received intravenous rtPA between January 2010 and May 2015. Clinical factors were compared between geriatric and nongeriatric patients. SBPs at the time of rtPA bolus and every hour thereafter were collected. The primary outcome was major neurological improvement (MNI) at 24 hours after thrombolysis. Results: Serial measures of SBP revealed different 10-hour courses between patients with and without MNI in the geriatric group. The difference in SBP tendency was statistically significant (p=0.049). In contrast, there was no significant difference in SBP change in the nongeriatric group (p=0.251). In univariate analysis, geriatric patients with MNI showed higher frequency of very early neurological improvement (VENI) at 1 hour after rtPA infusion (p=0.023) and lower level of SBP at 3 hours and 10 hours (p=0.037 and p=0.046, respectively). In multivariate analysis using a logistic regression model, VENI at 1 hour and SBP value after 10 hours were independently related to MNI. Conclusion: SBP level and its change during the first 10 hours after intravenous rtPA treatment are different between geriatric and nongeriatric patients. In the geriatric group, SBP decrease is predictive of neurological state at 24 hours after thrombolysis. In the nongeriatric group, SBP decrease is not associated with neurological outcome.