The ThRombolysis in UnconTrolled Hypertension (TRUTH) protocol: an observational study on treatment strategy of elevated blood pressure in stroke patients eligible for IVT

Zonneveld, Thomas P.; Algra, Ale; Dippel, Diederik W.J.; Kappelle, L. Jaap; Oostenbrugge, Robert J. van; Roos, Yvo B.W.E.M.; Wermer, Marieke J.H.; Worp, H. Bart van der; Nederkoorn, Paul J.; Kruyt, Nyika D.

doi:10.1186/s12883-015-0493-z

Cited by 9 publications

(4 citation statements)

References 31 publications

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“…The RIGHT-2 trial showed that functional outcomes were not improved with blood pressure reduction prior to stroke treatment (100). The Dutch ThRombolysis in Uncontrolled Hypertension (TRUTH) trial is an ongoing study evaluating whether actively lowering blood pressure below 185/110 mmHg affects stroke outcome in alteplase treated patients (101).…”

Section: Hypertension Treatment To Prevent Htmentioning

confidence: 99%

Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation

et al. 2021

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Hemorrhagic transformation (HT) is a common complication in patients with acute ischemic stroke. It occurs when peripheral blood extravasates across a disrupted blood brain barrier (BBB) into the brain following ischemic stroke. Preventing HT is important as it worsens stroke outcome and increases mortality. Factors associated with increased risk of HT include stroke severity, reperfusion therapy (thrombolysis and thrombectomy), hypertension, hyperglycemia, and age. Inflammation and the immune system are important contributors to BBB disruption and HT and are associated with many of the risk factors for HT. In this review, we present the relationship of inflammation and immune activation to HT in the context of reperfusion therapy, hypertension, hyperglycemia, and age. Differences in inflammatory pathways relating to HT are discussed. The role of inflammation to stratify the risk of HT and therapies targeting the immune system to reduce the risk of HT are presented.

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Section: Hypertension Treatment To Prevent Htmentioning

confidence: 99%

Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation

et al. 2021

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Section: Discussionmentioning

confidence: 99%

“…Nevertheless, as the differences of stroke severities and pretreatment BP levels existed between groups, our results were still unable to answer the above questions. A randomized trial evaluating active BP-lowering strategies for acute ischemic stroke is in progress and may provide more evidences [23,24]. Subgroup analysis according to stroke severity showed that admission BP excursion compromised thrombolysis effect in patients with severe stroke but not in those with moderate stroke.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke

Du¹,

Zhang

et al. 2023

Journal of Hypertension

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Background: Blood pressure (BP) excursion on admission was common in patients with acute ischemic stroke, but its influence on thrombolysis effect was not fully evaluated. Methods: Patients with acute ischemic stroke who received thrombolysis without subsequent thrombectomy were included. Admission BP excursion was defined as higher than 185/110 mmHg. Multivariate logistic regression analysis was used to evaluate the relationship between admission BP excursion and poor outcome as well as hemorrhage rates and mortality. Poor outcome was defined as a 90-day modified Rankin Scale score 3–6. Subgroup analysis was performed according to stroke severity, which was assessed by the National Institutes of Health Stroke Scale (NIHSS) score, and hypertension status. Results: A total of 633 patients were enrolled and 240 participants (37.9%) had admission BP excursion. Admission BP excursion was associated with poor outcome [adjusted odds ratio (OR) 0.64, 95% confidence interval 0.42–0.99, P = 0.046]. No significant difference was found regarding hemorrhage rates or mortality between patients with and without admission BP excursion. In subgroup analysis, admission BP excursion was related to poor outcome in patients with NIHSS score at least 7 (adjusted OR 1.89, 95% confidence interval 1.03–3.45, P = 0.038), but not in patients with NIHSS score less than 7 (P for interaction <0.001). Conclusion: Admission BP excursion above the guideline thresholds did not increase postthrombolysis hemorrhage risk or mortality, but was associated with poor outcome, especially in patients with severe stroke.

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“…Hypertension may also modify the clinical outcome in patients undergoing a specific treatment of AIS. Available evidence shows that arterial hypertension is related to poor functional outcome after intravenous thrombolysis [104]. However, in a recently published multicentre study of ischemic stroke in patients eligible for intravenous thrombolysis (ENCHANTED study), hypertension favored neither guideline-recommended blood pressure lowering nor intensive blood pressure lowering [68••].…”

Section: Bp Management In Acute Ischemic Stroke Patients With and Witmentioning

confidence: 99%

Blood Pressure Management in Acute Ischemic Stroke

et al. 2020

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Purpose of Review Abrupt blood pressure (BP) rise is the most common clinical symptom of acute ischemic stroke (AIS). However, BP alterations during AIS reflect many diverse mechanisms, both stroke-related and nonspecific epiphenomena, which change over time and across patients. While extremes of BP as well as high BP variability have been related with worse outcomes in observational studies, optimal BP management after AIS remains challenging. Recent Findings This review discusses the complexity of the factors linking BP changes to the clinical outcomes of patients with AIS, depending on the treatment strategy and local vessel status and, in particular, the degree of reperfusion achieved. The evidence for possible additional clinical markers, including the presence of arterial hypertension, and comorbid organ dysfunction in individuals with AIS, as informative and helpful factors in therapeutic decision-making concerning BP will be reviewed, as well as recent data on neurovascular monitoring targeting person-specific local cerebral perfusion and metabolic demand, instead of the global traditional parameters (BP among others) alone. Summary The individualization of BP management protocols based on a complex evaluation of the homeostatic response to focal cerebral ischemia, including but not limited to BP changes, may be a valuable novel goal proposed in AIS, but further trials are warranted.

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The ThRombolysis in UnconTrolled Hypertension (TRUTH) protocol: an observational study on treatment strategy of elevated blood pressure in stroke patients eligible for IVT

Cited by 9 publications

References 31 publications

Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation

Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation

Blood pressure excursion on admission and intravenous thrombolysis in ischemic stroke

Blood Pressure Management in Acute Ischemic Stroke

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