Thrombolysis and Uncontrolled Hypertension

Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is an effective treatment in acute ischemic stroke. However, IVT is contraindicated when blood pressure (BP) is above 185/110 mm Hg, because of an increased risk on symptomatic intracranial hemorrhage (sICH). In Dutch clinical practice, two distinct strategies are used in this situation.

The active strategy comprises lowering BP with antihypertensive agents below these thresholds to allow start of IVT. In the conservative strategy, IVT is administered only when BP drops spontaneously below protocolled thresholds.

We hypothesize that the active strategy leads to a better functional outcome three months after acute ischemic stroke. Secondary hypotheses are that this effect occurs despite increasing the number of sICHs, and could be attributable to a higher rate of IVT treatments and a shorter door-to-needle time.



The TRUTH is a prospective, observational, cluster-based, parallel group follow-up study; in which participating centers continue their current local treatment guidelines. Outcomes of patients admitted to centers with an active will be compared to those admitted to centers with a conservative strategy.

The TRUTH is the first large prospective study specifically studying IVT-candidates with elevated BP, and has the potential to change clinical practice and optimize acute stroke care in these patients.

We hypothesize that the active strategy leads to a better functional outcome than the conservative strategy three months after acute ischemic stroke, in patients with elevated pre-treatmen blood pressure otherwise eligible for intravenous thrombolysis.



Secondary hypotheses are that this effect occurs despite increasing the number of sICHs, and could be attributable to a higher rate of IVT treatments and a shorter door-to-needle time.

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Patients admitted to centers with an active strategy will be compared to those admitted to centers with a conservative strategy.