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Background <p>Blood pressure (BP) management after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) remains challenging, and evidence on how BP levels relate to prognosis is inconsistent. We performed a systematic review and meta-analysis to evaluate associations between pre-/post-treatment BP levels and clinical outcomes after IVT.</p> Methods <p>We conducted this systematic review and meta-analysis in accordance with PRISMA. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 8, 2026, restricted to English-language published clinical studies. Adults with AIS treated with intravenous alteplase were eligible. Pre-treatment BP was defined as the measurement closest to IVT initiation; post-treatment BP preferentially referred to the mean BP within 2–4&#xa0;h after completion of alteplase infusion (or 24–72&#xa0;h when unavailable). Outcomes included 3-month functional outcome (favorable modified Rankin Scale (mRS) 0–2 vs. unfavorable mRS 3–6), symptomatic intracranial hemorrhage (sICH; study-specific definitions), and 3-month mortality. Mean differences (MDs) and odds ratios (ORs) were pooled using fixed- or random-effects models based on heterogeneity.</p> Results <p>Thirty-four studies were included. For functional outcome, 5,582 patients had favorable outcome and 5,179 had unfavorable outcome; the weighted mean pre-treatment SBP was 150.0 vs. 151.5 mmHg, respectively, and the pooled MD indicated lower pre-treatment SBP in the favorable group (MD = − 5.58 mmHg, 95% CI − 9.04 to − 2.12; I²=79%). For post-treatment SBP, 4,963 vs. 4,467 patients were included; the weighted mean SBP was 144.9 vs. 149.0 mmHg, and the pooled MD was − 4.09 mmHg (95% CI − 4.98 to − 3.20; I²=0%). For sICH, 279/12,362 (2.26%) patients developed sICH; the weighted mean pre-treatment SBP was 151.6 vs. 157.9 mmHg (no sICH vs. sICH), and the pooled MD was − 5.89 mmHg (95% CI − 8.26 to − 3.51; I²=0%). For post-treatment SBP, 182/10,541 (1.73%) patients developed sICH; the weighted mean SBP was 147.2 vs. 159.7 mmHg, and the pooled MD was − 11.71 mmHg (95% CI − 15.05 to − 8.37; I²=45%). Evidence for mortality and BP variability was limited.</p> Conclusions <p>Higher SBP before and after IVT was associated with poorer 3-month functional outcome and with sICH. Further prospective studies with standardized BP ascertainment and outcome definitions are needed.</p>

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Relationship between blood pressure level with prognosis of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月9日

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  • Yingbin Li,
  • Gan Huang,
  • Shaoxue Li,
  • Haolin Liu,
  • Shengju Li,
  • Xiaoxin Bai,
  • Jun Cai

摘要

Background

Blood pressure (BP) management after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) remains challenging, and evidence on how BP levels relate to prognosis is inconsistent. We performed a systematic review and meta-analysis to evaluate associations between pre-/post-treatment BP levels and clinical outcomes after IVT.

Methods

We conducted this systematic review and meta-analysis in accordance with PRISMA. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 8, 2026, restricted to English-language published clinical studies. Adults with AIS treated with intravenous alteplase were eligible. Pre-treatment BP was defined as the measurement closest to IVT initiation; post-treatment BP preferentially referred to the mean BP within 2–4 h after completion of alteplase infusion (or 24–72 h when unavailable). Outcomes included 3-month functional outcome (favorable modified Rankin Scale (mRS) 0–2 vs. unfavorable mRS 3–6), symptomatic intracranial hemorrhage (sICH; study-specific definitions), and 3-month mortality. Mean differences (MDs) and odds ratios (ORs) were pooled using fixed- or random-effects models based on heterogeneity.

Results

Thirty-four studies were included. For functional outcome, 5,582 patients had favorable outcome and 5,179 had unfavorable outcome; the weighted mean pre-treatment SBP was 150.0 vs. 151.5 mmHg, respectively, and the pooled MD indicated lower pre-treatment SBP in the favorable group (MD = − 5.58 mmHg, 95% CI − 9.04 to − 2.12; I²=79%). For post-treatment SBP, 4,963 vs. 4,467 patients were included; the weighted mean SBP was 144.9 vs. 149.0 mmHg, and the pooled MD was − 4.09 mmHg (95% CI − 4.98 to − 3.20; I²=0%). For sICH, 279/12,362 (2.26%) patients developed sICH; the weighted mean pre-treatment SBP was 151.6 vs. 157.9 mmHg (no sICH vs. sICH), and the pooled MD was − 5.89 mmHg (95% CI − 8.26 to − 3.51; I²=0%). For post-treatment SBP, 182/10,541 (1.73%) patients developed sICH; the weighted mean SBP was 147.2 vs. 159.7 mmHg, and the pooled MD was − 11.71 mmHg (95% CI − 15.05 to − 8.37; I²=45%). Evidence for mortality and BP variability was limited.

Conclusions

Higher SBP before and after IVT was associated with poorer 3-month functional outcome and with sICH. Further prospective studies with standardized BP ascertainment and outcome definitions are needed.