Meng Lee1, Bruce Ovbiagele1, Keun-Sik Hong1, Yi-Ling Wu1, Jing-Er Lee1, Neal M Rao1, Wayne Feng1, Jeffrey L Saver2. 1. From the Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (M.L., Y.-L.W.); Department of Neurosciences, Medical University of South Carolina, Charleston (B.O., W.F.); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea (K.-S.H.); Department of Neurology, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan (J.-E.L.); and Stroke Center and Department of Neurology, Geffen School of Medicine, University of California, Los Angeles (J.-E.L., N.M.R., J.L.S.). 2. From the Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan (M.L., Y.-L.W.); Department of Neurosciences, Medical University of South Carolina, Charleston (B.O., W.F.); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea (K.-S.H.); Department of Neurology, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan (J.-E.L.); and Stroke Center and Department of Neurology, Geffen School of Medicine, University of California, Los Angeles (J.-E.L., N.M.R., J.L.S.). jsaver@mednet.ucla.edu.
Abstract
BACKGROUND AND PURPOSE: Elevated blood pressure is common in acute stage of ischemic stroke and the strategy to manage this situation is not well established. We therefore conducted a meta-analysis of randomized controlled trials comparing active blood pressure lowering and control groups in early ischemic stroke. METHODS: Pubmed, EMBASE, and Clinicaltrials.gov from January 1966 to March 2015 were searched to identify relevant studies. We included randomized controlled trials with blood pressure lowering started versus control within 3 days of ischemic stroke onset. The primary outcome was unfavorable outcome at 3 months or at trial end point, defined as dependency or death, and the key secondary outcome was recurrent vascular events. Pooled relative risks and 95% confidence intervals were calculated using random-effects model. RESULTS: The systematic search identified 13 randomized controlled trials with 12 703 participants comparing early blood pressure lowering and control. Pooling the results with the random-effects model showed that blood pressure lowering in early ischemic stroke did not affect the risk of death or dependency at 3 months or at trial end point (relative risk, 1.04; 95% confidence interval, 0.96-1.13; P=0.35). Also, blood pressure lowering also had neutral effect on recurrent vascular events, as well as on disability or death, all-cause mortality, recurrent stroke, and serious adverse events. CONCLUSIONS: This meta-analysis suggested blood pressure lowering in early ischemic stroke had a neutral effect on the prevention of death or dependency.
BACKGROUND AND PURPOSE: Elevated blood pressure is common in acute stage of ischemic stroke and the strategy to manage this situation is not well established. We therefore conducted a meta-analysis of randomized controlled trials comparing active blood pressure lowering and control groups in early ischemic stroke. METHODS: Pubmed, EMBASE, and Clinicaltrials.gov from January 1966 to March 2015 were searched to identify relevant studies. We included randomized controlled trials with blood pressure lowering started versus control within 3 days of ischemic stroke onset. The primary outcome was unfavorable outcome at 3 months or at trial end point, defined as dependency or death, and the key secondary outcome was recurrent vascular events. Pooled relative risks and 95% confidence intervals were calculated using random-effects model. RESULTS: The systematic search identified 13 randomized controlled trials with 12 703 participants comparing early blood pressure lowering and control. Pooling the results with the random-effects model showed that blood pressure lowering in early ischemic stroke did not affect the risk of death or dependency at 3 months or at trial end point (relative risk, 1.04; 95% confidence interval, 0.96-1.13; P=0.35). Also, blood pressure lowering also had neutral effect on recurrent vascular events, as well as on disability or death, all-cause mortality, recurrent stroke, and serious adverse events. CONCLUSIONS: This meta-analysis suggested blood pressure lowering in early ischemic stroke had a neutral effect on the prevention of death or dependency.
Authors: A Maud; G J Rodriguez; A Vellipuram; F Sheriff; M Ghatali; V Gupta; R Khatri; S Cruz-Flores Journal: Curr Cardiol Rep Date: 2021-05-07 Impact factor: 2.931