Active Blood Pressure Reduction to Allow for Intravenous Stroke Thrombolysis

Stroke thrombolysis typically is contraindicated with blood pressure >185/110 mm Hg out of concern for increased hemorrhage risk. Current guidelines recommend active treatment to reduce blood pressure below that target so that stroke thrombolysis can be administered. But is such a strategy justified? TRUTH was an observational cluster-based study conducted at 37 stroke centers in the Netherlands that agreed to consistently adhere to either an active blood pressure–lowering strategy or a non-lowering strategy for ischemic stroke patients with blood pressure >185/110 mm Hg. (The specific strategy adopted at each center was not randomized.) The 27 centers that agreed to an active blood pressure–lowering strategy enrolled 853 patients and the 1…