TOPLINE:
An increase in systolic blood pressure (sBP) within the first 24 hours after alteplase treatment was associated with worse functional outcomes at 3 months after acute ischaemic stroke. Both higher sBP at baseline and increases in sBP during the first 24 hours were linked to poorer neurologic function. Additionally, higher sBP at baseline independently increased the risk for symptomatic intracerebral haemorrhage within 48 hours from the onset of stroke.
METHODOLOGY:
- Researchers in Norway conducted a post hoc analysis of a phase 3 randomised controlled trial (NOR-TEST) to evaluate the effect of 24-hour sBP trajectories on neurologic and functional outcomes in patients with acute ischaemic stroke treated with intravenous alteplase.
- They included 424 patients with acute ischaemic stroke (mean age, 70.8 years; 35.4% women) who were hospitalised within 4.5 hours of symptom onset and treated with intravenous alteplase during 2012-2016.
- The primary outcome was functional outcome at 3 months post-stroke, defined using the modified Rankin scale (mRS; good outcome, a mRS score of 0-2).
- Secondary outcomes were neurologic function evaluated using the National Institutes of Health Stroke Scale at 24 hours following alteplase treatment and symptomatic intracerebral haemorrhage reporting within 48 hours.
TAKEAWAY:
- Overall, 309 (75.1%) patients achieved a good functional outcome; those who experienced a reduction in sBP during the first 24 hours had better outcomes than those who experienced an increase in sBP during the first 24 hours (77.9% vs 69.0%; P < .001).
- An increase in sBP between baseline and 24 hours was significantly associated with worse functional outcomes at 3 months post-stroke after adjusting for variables (odds ratio [OR], 0.933; P = .03).
- Moreover, an increase in sBP within the first 24 hours (beta-coefficient [β], 0.167), higher sBP at baseline (β, 0.072), and more severe stroke symptoms at admission (β, 0.517; P < .05 for all) were associated with worse neurologic function at 24 hours.
- After adjustments, each 1 mm Hg increase in baseline sBP increased the odds of symptomatic intracerebral haemorrhage by 2.2% within 48 hours from the onset of stroke (OR, 1.022; P = .022).
IN PRACTICE:
"[The study] results indicate that high blood pressure at baseline is detrimental and associated with severe outcomes. Large fluctuations in systolic blood pressure, especially increase in sBP the first 24 hours after thrombolysis should be avoided," the authors wrote.
SOURCE:
This study was led by Ole Morten Rønning, MD, PhD, Department of Neurology, Division of Medicine, Akershus University Hospital, Oslo, Norway. It was published online on December 05, 2025, in the Journal of Stroke and Cerebrovascular Diseases.
LIMITATIONS:
This post hoc analysis included only patients treated with alteplase. BP monitoring was limited to only three measurements within the first 24 hours, potentially missing important BP values. This study did not consider antihypertensive medication use prior to thrombolysis.
DISCLOSURES:
This study was funded by the Research Council of Norway. The authors declared having no competing interests
