Sex, Diastolic Blood Pressure, and Outcome after Thrombolysis for Ischemic Stroke

Background. The goal of this study was to identify differences in risk factors and functional outcome between the two sexes in patients treated with thrombolysis for ischemic stroke. Methods. This cohort study audited data from patients treated with thrombolysis for ischemic stroke during a 3-year period at S？dersjukhuset, Stockholm. Results. Of the 355 patients included in the study, 162 (45%) were women and 193 (54%) were men. Women were older with a median age of 76 years; median age for men was 69 years ( ). Diastolic blood pressure was lower for women compared to men ( ). At admission fewer women had a favorable modified Rankin Scale score compared to men (93.8% versus 99%, ). Three months after discharge functional status did not differ significantly between the two sexes. Diastolic blood pressure was associated to functional outcome only in men when sex specific odds ratios were calculated (OR, 5.7; 95% CI, 1.7–20). Conclusion. The study indicates that females appear to gain a relatively greater benefit from thrombolytic therapy than men due to a better functional recovery. A higher diastolic blood pressure increases the risk for a worse prospective functional status in men. 1. Introduction Stroke is the primary cause of severe acquired disability in adults with 500,000 new cases each year in Europe [1, 2]. Administration of recombinant tissue plasminogen activator (rtPA), alteplase (Actilyse), within 4.5？h after onset of stroke, is an efficient treatment in patients where an intracerebral hemorrhage and other contraindications have been excluded [3–6]. Overall, women and men have a similar incidence for ischemic cerebrovascular disease but women are more frequently hit by stroke later in life than men [7]. Several epidemiological studies have shown that women having more severe stroke symptoms at admission, a worse prognosis, are less likely to return home and to live independently [8, 9] and have an overall worse outcome after ischemic stroke than men [10, 11]. However, some studies show a similar outcome for men and women after stroke [12, 13] and there is evidence that women treated with tPA benefit at least as much as men [14–16]. Very recently a study from the prospective multinational Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR) suggested a possible larger beneficial effect of intravenous tPA in women compared with men [17]. Several recent studies have shown the same risk of bleeding and positive treatment effects in patients above 80 years old even though this age group has an overall