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Comment & Response |

Validation of the Association Between Neurologic Improvement With Decline in Blood Pressure and Recanalization in Stroke—Reply

Nandakumar Nagaraja, MD, MS1,2; Harold P. Adams Jr, MD2; José G. Merino, MD3
[+] Author Affiliations
1Stroke Diagnostics and Therapeutics Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
2University of Iowa, Iowa City
3Johns Hopkins Community Physicians, Bethesda, Maryland
JAMA Neurol. 2015;72(4):477-478. doi:10.1001/jamaneurol.2014.4690.
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In Reply We thank Yeo and colleagues for their letter and for presenting their data. In our study,1 we evaluated whether the association of (1) a decline in systolic blood pressure (BP) by more than 20 mm Hg; (2) neurological improvement in National Institutes of Health Stroke Scale (NIHSS) score by 4 or more points or NIHSS score of 0 at 24 hours after intravenous (IV) tissue plasminogen activator (tPA); or (3) both a decline in systolic BP and neurological improvement was associated with recanalization when imaged at 24 hours after IV tPA. For the measurement of the decline in BP, we calculated the difference between the initial triage BP and the average of the last 3-hour readings prior to the 24-hour magnetic resonance angiography. To minimize the bias and error in using only 1 BP reading at the 24-hour point, we took the average of the hourly BP readings in the 3-hour period prior to the 24-hour magnetic resonance angiography and we assumed this would best represent the BP change in relation to recanalization status at that time. There may be some methodological differences between our study and the study by Yeo and colleagues such as calculation of the difference in BP at 24 hours after IV tPA.


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April 1, 2015
Leonard L. L. Yeo, MBBS, MRCP; Yao F. Chong, MBBS; Vijay K. Sharma, MBBS
1Division of Neurology, Department of Medicine, National University Health System, Singapore
JAMA Neurol. 2015;72(4):477. doi:10.1001/jamaneurol.2014.4705.
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