To assess the impact of antihypertensive agents on time to intravenous thrombolysis in acute ischemic stroke treatment.

Treatment of stroke with intravenous thrombolysis (IVT) should be as rapid as possible. A subset of these patients present with blood pressures above that considered safe for thrombolytic administration. Guideline statements are ambivalent regarding which antihypertensive agent should be used to meet the goal blood pressure (BP<185/110) prior to IVT.

Data were reviewed from consecutive patients at a single academic medical institution treated with IVT from 01/2014 to 07/2018 and collected door-to-needle (DTN) time, antihypertensive agent (if used), and antihypertensive-to-needle (ATN) time. Patients were grouped by initial agent administered. An independent samples t-test was used to compare the labetalol and nicardipine group DTN and ATN times as well as DTN times for patients not receiving antihypertensive therapy with times for those who did. A one-way ANOVA was performed to compare DTN times across all groups.

Analysis included 205 patients: 149 receiving no antihypertensive, 42, 12, and 2 receiving labetalol, nicardipine, and hydralazine, respectively. Those not administered antihypertensive prior to IVT had shorter DTN times (53.05 min versus 61.96 min, p=0.039). Although not statistically significant, there was a trend towards longer DTN (64.76  vs. 51.33 minutes, p=0.205) and ATN times (18.02  vs. 10.58 minutes, p=0.171) in the labetalol group. There was no significant difference in DTN time across all groups (F=2.213, p=0.088), although labetalol trended towards higher times than those not administered any agent on post-hoc Tukey HSD test (p=0.071).

Patients requiring antihypertensive treatment did experience slower DTN times. Choice of antihypertensive agent did not affect DTN times; however there was a trend towards slower times with labetalol. This study is limited by relatively small sample size. Pooling data from multiple institutions could provide a more robust assessment and inform clinical practice.