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ESOC 2024 | TRUTH study challenges guidelines on active blood pressure lowering prior to thrombolysis

Nyika Kruyt, MD, PhD, Leiden University Medical Centre, Leiden, Netherlands, shares the findings of the Thrombolysis and Uncontrolled Hypertension (TRUTH) cluster-based observational study, which investigated the value of active blood pressure (BP) lowering prior to intravenous thrombolysis (IVT) in patients with BP greater than 185/110mmHg. Current guidelines recommend rapid lowering of BP in these patients given the increased risk of intracerebral hemorrhage associated with hypertension, yet there is a lack of strong evidence to support this approach. Comparing patients treated in centers that adhere to an active blood pressure-lowering strategy to those treated at centers following a non-lowering strategy, no significant differences in functional outcomes or intracerebral hemorrhage rates were seen, despite higher rates of thrombolysis and shorter treatment delays in the active lowering group. Overall, these findings do not support the current recommendations of rapid, active blood pressure lowering and evidence the need for additional randomized trials. This interview took place at the 10th European Stroke Organisation Conference (ESOC) 2024 in Basel, Switzerland.

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