Comparison of Blood Pressure Changes during the First 24 Hours after Tissue Plasminogen ActivatorAdministration in Patients with and without Intracerebral Hemorrhage

Mohammadzadeh Vardin, H; Taher Aghdam, A; Farhodi, F; Sadeghi Hekmabadi, E

doi:10.22034/ijs.2026.741846

Comparison of Blood Pressure Changes during the First 24 Hours after Tissue Plasminogen ActivatorAdministration in Patients with and without Intracerebral Hemorrhage

Authors

H Mohammadzadeh Vardin ¹

A Taher Aghdam ²

F Farhodi ²

E Sadeghi Hekmabadi ²

¹ Neurologist, Tabriz University of Medical Sciences, Imam Reza Hospital

² Professor of Neurology, Tabriz University of Medical Sciences, Imam Reza Hospital

https://doi.org/10.22034/ijs.2026.741846

Abstract

Background and Objective: Recent studies have highlighted the importance of temporal blood pressure indices, including mean and peak blood pressure during the 2–8-hour, 8–24-hour, and overall 24-hour periods, in predicting the risk of hemorrhage and severe complications. Despite considerable advances in this field, a substantial gap remains in the evidence regarding the effect of blood pressure fluctuations on the occurrence of hemorrhages requiring neurosurgical intervention following administration of the thrombolytic agent alteplase. The present study aimed to address this issue through a detailed evaluation of data from patients admitted to a dedicated stroke care unit (SCU).
Materials and Methods: This retrospective study included all patients with ischemic stroke admitted to the SCU of Imam Reza Hospital, Tabriz University of Medical Sciences, between 2020 and 2022. Eligibility criteria required complete clinical and paraclinical data, no prior use of anticoagulant medications or contraindications to thrombolytic therapy, and accurate blood pressure recordings during the first 24 hours following alteplase administration. Blood pressure was recorded every 15 minutes during the first 2 hours, every 30 minutes for the subsequent 6 hours, and then hourly until the completion of the first 24 hours; these data were extracted from medical records. Variables assessed included age, sex, blood pressure values, and the frequency of blood pressure measurements. Symptomatic intracerebral hemorrhage was defined as parenchymal hematoma type 2. Chi-square and independent-samples t-tests were used for comparisons, with a p-value less than 0.05 considered statistically significant.
Results: Comparison of systolic blood pressure changes between the hemorrhage and non-hemorrhage groups after TPA administration showed no statistically significant difference at hospital admission (P = 0.998). However, systolic blood pressure changes were significantly greater in the hemorrhage group during the first 2 hours (P = 0.048) and during the 2-to-8-hour period (P = 0.004). No statistically significant difference was observed between the two groups during the 8-to-24-hour period
(P = 0.879). Diastolic blood pressure at hospital admission also did not differ significantly between groups (P = 0.852), and no significant between-group difference was found during the first 2 hours (P = 0.524). In contrast, diastolic blood pressure during the 2-to-8-hour period was significantly higher in the hemorrhage group than in the non-hemorrhage group (P = 0.004). No statistically significant difference in diastolic blood pressure was observed between groups during the 8-to-24-hour period (P = 0.744).
Conclusion: This study demonstrated that patients who developed intracerebral hemorrhage following thrombolysis exhibited higher diastolic blood pressure during the first 24 hours compared to other patients, while the difference in systolic blood pressure was not statistically significant overall. Surgical and pharmacological interventions were performed according to the severity and location of the hemorrhage, as well as the patients’ clinical condition. These findings underscore the importance of close blood pressure monitoring and individualized therapeutic decision-making in preventing thrombolysis-related complications.

Keywords

Blood Pressure

Fibrinolytic Agents

Ischemic Stroke

Tissue Plasminogen Activator

Cerebral Hemorrhage

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