Impact of antihypertensive administration strategy on time to thrombolysis in acute ischemic stroke

Patients with acute ischemic stroke (AIS) often present with elevated blood pressure (> 185/110 mmHg) which requires treatment before thrombolysis. The purpose of this study is to determine the optimal strategy to lower blood pressure before thrombolysis in AIS.

This is a retrospective study of adult patients diagnosed with AIS who received antihypertensives before thrombolysis between March 2022 and November 2023 at Methodist LeBonheur Healthcare. Cohorts were divided by the initial type of antihypertensive used: intravenous push (IVP) or continuous infusion (CI). The primary outcome was antihypertensive-to-needle (ATN) time. Other outcomes included door-to-needle (DTN) time, functional outcomes, need for rescue antihypertensives, and adverse effects.

One hundred patients were included: 44 in the IVP group and 56 in the CI group. The median age was 67 years. The highest systolic blood pressure before thrombolysis was higher in the CI group (207 mmHg versus 193 mmHg, p < 0.001). The median ATN time was shorter in the IVP group (9.5 min versus 15 min, p = 0.005). Door-to-needle time was shorter in the IVP group (57.5 min versus 67 min, p = 0.038). There were no statistically significant differences in use of rescue antihypertensives, adverse effects, or functional outcomes at discharge.

This study demonstrates that IVP antihypertensives as the initial antihypertensive strategy may decrease the time to thrombolysis in AIS patients who require blood pressure lowering without increasing rates of adverse effects. Functional outcomes were not impacted positively or negatively. Larger prospective studies are needed to confirm these results.