Blood Pressure Management in Early Ischemic Stroke

Saver, Jeffrey L.

doi:10.1001/jama.2013.282544

Cited by 35 publications

(33 citation statements)

References 10 publications

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“…Conversely, when blood pressure was actively treated in the subacute time period, there apparently was little risk of infarct extension and neurological deterioration because of failure of collateral circulation. 3 It is likely that the fate of the threatened penumbra has mostly been determined by 10 hours after onset. 23 These findings in patients with ischemic stroke contrast with those in intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Effect of Blood Pressure Lowering in Early Ischemic Stroke

Lee

Ovbiagele

Hong

et al. 2015

Stroke

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103

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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.

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Section: Discussionmentioning

confidence: 99%

Effect of Blood Pressure Lowering in Early Ischemic Stroke

Lee

Ovbiagele

Hong

et al. 2015

Stroke

Self Cite

103

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“…In addition, some experts think that hypertension control should be started within 12-36 h after stroke onset, because physiologic reasoning suggest that hypotension within 12 h may break collateral circulation compensation, which is very vital within the first few hours after stroke. There is also another thought that hypertension control started before early neurologic worsening can help to avert secondary injury [17] . Under these circumstances, we performed this meta-analysis to investigate the safety and effect of early BP lowering (started within the first 48 h) after AIS.…”

Section: Discussionmentioning

confidence: 99%

Effects of Early Hypertension Control after Ischaemic Stroke on the Outcome: A Meta-Analysis

Liu

Li²,

Li³

et al. 2015

Cerebrovasc Dis

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Background: Accumulating evidence suggests that high blood pressure (BP) increases the risk of cerebral oedema and haemorrhagic transformation of the ischaemic stroke (IS), and that low BP in acute ischaemic stroke (AIS) is associated with a poor prognosis. The best possible management of hypertension after AIS is still uncertain. Materials and Methods: English databases were searched to identify relevant randomized controlled trials assessing the effects of early BP lowering (started within the first 48 h) after IS on outcome from January 1990 to August 2015. We set strict inclusion criteria and used the Review Manager 5.2 software from Cochrane Collaboration to calculate the combined risk ratio (RR). Result: Eight studies met our criteria. Early BP lowering after AIS did not significantly affect the risk of early and long-term death (RR 1.22; 95% CI 0.69-2.16 and RR 1.03; 95% CI 0.62-1.71), early and long-term dependency (RR 1.02; 95% CI 0.94-1.10 and RR 1.07; 95% CI 0.84-1.36), early and long-term death or dependency (RR 1.04; 95% CI 0.94-1.19 and RR 1.00; 95% CI 0.95-1.05), long-term stroke recurrence (RR 0.74; 95% CI 0.49-1.11), long-term myocardial infarction (RR 0.99; 95% CI 0.27-3.61), and long-term vascular events (RR 0.97; 95% CI 0.72-1.31). Conclusion: Our results revealed neither support nor opposition to early BP lowering (started within 48 h) after AIS; individualized BP management based on the patients' condition may be a good choice.

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“…38-40 There are competing concerns about preventing recurrence versus reducing cerebral perfusion pressure in regards to initiating BP management in the acute setting after stroke. 41 …”

Section: Timing Of Reduction Of High Blood Pressure For Recurrenmentioning

confidence: 99%