Blood Pressure Reduction in the Acute Phase of an Ischemic Stroke Does Not Improve Short- or Long-Term Dependency or Mortality

Abstract

The purpose of this study was to perform a meta-analysis of current literature to determine whether lowering blood pressure (BP) during the acute phase of an ischemic stroke improves short- and long-term outcomes.PubMed, Cochrane, and Embase were searched until September 5, 2014 using combinations of the search terms: blood pressure reduction, reduced blood pressure, lowering blood pressure, ischemic stroke, acute stroke, and intra-cerebral hemorrhage. Inclusion criteria were randomized controlled trial and patients with acute stroke (ischemic or hemorrhagic) treated with an antihypertensive agent or placebo. Outcome measures were change in systolic and diastolic BP (SBP, DBP) after treatment, and short- and long-term dependency and mortality rates.A total of 459 studies were identified, and ultimately 22 studies were included in the meta-analysis. The total number of participants in the treatment groups was 5672 (range, 6–2308), and in the control groups was 5416 (range, 6–2033). In most studies, more than 50% of the participants were males and the mean age was more than 60 years. The mean follow-up time ranged from 5 days to 12 months. As expected, treatment groups had a greater decrease in BP than control groups, and this effect was seen with different classes of antihypertensive drugs. Short-term and long-term dependency rates were similar between treatment and control groups (short-term dependency: pooled odds ratio [OR] = 1.041, 95% confidence interval [CI]: 0.936–1.159, P = 0.457; long-term dependency: pooled OR = 1.013, 95% CI: 0.915–1.120, P = 0.806). Short-term or long-term mortality was similar between the treatment and control groups (short-term mortality: pooled OR = 1.020, 95% CI: 0.749–1.388, P = .902; long-term mortality: pooled OR = 1.039, 95% CI: 0.883–1.222, P = 0.644).Antihypertensive agents effectively reduce BP during the acute phase of an ischemic stroke, but provide no benefit with respect to short- and long-term dependency and mortality.

Effects of effective acute anti-hypertensive therapy on ischemic stroke prognosis: a meta-analysis of randomized controlled trials

“…The neutral effect on functional outcome, i.e., death or dependency and mRS distribution, was also found in previous studies and meta-analyses [20,35,[41][42][43]. Death or disability after a stroke event has led to plenty of harm and placed burdens on stroke patients and their family members, and this was the most important prognosis [50].…”

“…The period of reported outcomes varied from 7 days to 1 year for most studies in this eld, so data in the short term (7-30 days) and long term (3 months or longer), along with their combination at the follow-up endpoint, were analyzed. The short-term and longterm de nition here was modi ed from reported studies in this eld [25,35,[40][41][42][43]. For additional details on functional outcome, the distribution of mRS scores was assessed.…”

The Association between Arterial Stiffness, Initial Stroke Severity, and 3-Week Outcomes in Patients with Ischemic Stroke

“…Whether or not high BP is associated with poor outcome after acute ischaemic stroke has been extensively debated with conflicting results. Recently, three meta-analyses have neither supported nor opposed early BP lowering in acute ischaemic stroke with respect to the effect on short or long term morbidity and mortality 19,20,21 . It may instead be BP variability 22,23 and extremes of BP 24,25 that have an influence on poorer outcomes in the acute post-stroke phase.…”

Evaluation and Management of Atherosclerotic Carotid Stenosis

“…50 Trials of antihypertensive therapy at the time of an acute stroke have not shown significant effects on short or long-term outcomes. 51,52 Nonetheless, there remains concern that rapid lowering of blood pressure immediately following stroke in a patient with symptomatic carotid disease might increase infarct volume and worsen neurological deficit. For asymptomatic patients, the AHA strongly recommends maintaining blood pressure below 140/90 mm Hg.…”