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Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Faculty of Medicine, Khon Kaen University Introduction Blood pressure variation (BPV) was one of the risk factors for unfavorable stokes outcomes. However, the association between BPV and short-term outcomes in stroke patients after received thrombolysis (recombinant tissue plasminogen activator; rt-PA) was limited. Objectives We aimed to determine the association between BPV and mortality and symptomatic intracerebral hemorrhage (s-ICH) in stroke patients after rt-PA administration. Methods This was a cross-sectional study in a specialized stroke unit of our university hospital, during 2015-2019. Adult ischemic-stroke patients who were eligible for receiving rt-PA were enrolled. Supine BP was measured just before starting rt-PA and at 0, 4, 8, 12, 16, 20, and 24 hours after completing rt-PA administration. The standard deviation (SD), coefficient of variation (CV), and successive variation (SV) of both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were calculated. Final outcomes were in-hospital mortality, or s-ICH. Results There were 278 patients enrolled, 138 men (49.6%), and mean age 65 ± 13 years old. Ten patients died (3.6%) and 27 patients had s-ICH (9.7%). There were 86 (30.9%) patients who received IV nicardipine before and after rt-PA. All BPV profiles of SBP were associated with mortality and s-ICH. Odds ratio (OR) for mortality were as follows; SD, 1.10 (1.02-1.19); CV, 1.13 (1.02-1.25); and SV, 1.07 (1.01-1.13), and OR for s-ICH were as follows; SD, 1.07 (1.02-1.14); CV, 1.11 (1.03-1.19); and SV, 1.05 (1.01-1.10). The BPV profiles of DBP also showed significant positive association with mortality and s-ICH. However, mean SBP and DBP, and time to rt-PA were not associated with both outcomes. Conclusions BPV profiles of both SBP and DPB were positively associated with mortality and s-ICH in stroke patients after receiving rt-PA, independent of BP levels. Further study on the optimal BPV and the treatment towards it is crucial.

The impact of blood pressure variation on mortality and symptomatic intracerebral hemorrhage in stroke patients after thrombolytic therapy