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

Liu, Shuping; Li, Chengyan; Li, Tao; Xiong, Jing; Zhao, Xueqing

doi:10.1159/000441097

Cited by 17 publications

(16 citation statements)

References 29 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Ormerod

Ali

Cameron

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Objectives: Vascular compliance is emerging as a useful cardiovascular risk factor.The aim of this study was to investigate the association between arterial stiffness and stroke severity at presentation and at three weeks. Methods:From an initial sample of 73 patients, 42 were included (55% male, mean age 71 years) with acute ischaemic stroke, over a 15 month period. Stroke subtypes were classified into LACI, PACI and POCI. Arterial stiffness was measured by QKD using 24-hour ambulatory blood pressure and ECG monitoring. The measured QKD values were then corrected for a heart rate of 60bpm and a systolic blood pressure (SBP) of 100 mmHg (QKD 100-60 ). Stroke severity was assessed on admission and after 3 weeks, using the National Institute of Health Stroke Scale (NIHSS). Results:There was a non-significant weak correlation between initial stroke severity and QKD 100-60 (r= -0.3, p = 0.08). This correlation was weaker at 3 weeks (r= 0.125, p=0.47). There was no difference in NIHSS at week 0 and 3, or QKD 100-60, between the different stroke types (LACI, PACI and POCI) or dipper versus non-dippers and reverse dippers. Conclusions:This study highlights the need for further research into the association between QKD and initial stroke severity.

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Section: Discussionmentioning

confidence: 99%

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

Ormerod

Ali

Cameron

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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“…These trials have mostly been conducted in patients with a mild-to-moderate acute ischemic stroke. Overall, they indicated that BP lowering had a neutral effect on death or dependency [9] .…”

confidence: 99%

Early Blood Pressure Reduction in Acute Ischemic Stroke with Various Severities: A Subgroup Analysis of the CATIS Trial

Li²,

Zhang³

et al. 2016

Cerebrovasc Dis

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Background: Clinical trials have generally showed a neutral effect of blood pressure (BP) reduction on clinical outcomes among acute ischemic stroke patients. We conducted a prespecified subgroup analysis to assess whether disease severity modifies the effect of early antihypertensive treatment on death and disability among patients with acute ischemic stroke. Methods: In the China Antihypertensive Trial in Acute Ischemic Stroke, 4,071 patients with acute ischemic stroke and elevated BP were randomly assigned to receive antihypertensive treatment or to discontinue all hypertension medications within 48 h of symptom onset. The primary outcome was a combination of death and major disability at 14 days or hospital discharge. In this subgroup analysis, participants were categorized into 3 groups according to their baseline NIH Stroke Scale (NIHSS) scores (0-4, 5-15, or ≥16). Results: At 24 h after randomization, mean systolic BP differences (95% CIs) were -8.5 (-10.0 to -7.1), -9.8 (-11.4 to -8.3), and -9.1 (-14.4 to -3.8) mm Hg between the treatment and control groups (all p values <0.001) for patients with a baseline NIHSS score of 0-4, 5-15, and ≥16, respectively. At day 7 after randomization, the corresponding mean systolic BP differences were -9.3 (-10.5 to -8.2), -9.1 (-10.3 to -7.8), and -10.1 (-15.1 to -5.1) mm Hg between the treatment and control groups (all p values <0.001). The primary outcome was not significantly different between the treatment and control groups at day 14 or hospital discharge among all NIHSS subgroups (p value for homogeneity = 0.66). ORs (95% CI) associated with treatment were 1.14 (0.87-1.49, p = 0.33), 1.04 (0.86-1.25, p = 0.70), and 0.67 (0.18-2.44, p = 0.54) for patients with a baseline NIHSS score of 0-4, 5-15, and ≥16, respectively. The composite outcome of death and major disability at 3-month follow-up did not differ between the 2 comparison groups for all NIHSS subgroups. In addition, vascular events and recurrent stroke were not significantly different between the 2 comparison groups at the 3-month follow-up visit among all NIHSS subgroups except that there was a suggestive risk reduction for recurrent stroke among those with an NIHSS score of 5-15 (OR 0.45, 95% CI 0.20-0.99, p = 0.05). Conclusion: Early BP reduction with antihypertensive medications did not reduce or increase the risk of death, major disabilities, recurrent instances of stroke, and vascular events in acute ischemic stroke patients with a variety of disease severities.

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“…The recent meta-analysis by Liu et al [11] showed that early BP lowering after AIS did not significantly affect the risk of early and long-term death, early and long-term dependency, early and long-term death or dependency, long-term stroke recurrence, long-term myocardial infarction, and long-term vascular events. However, the included studies were limited by the late recruitment (many hours after stroke onset) and smaller BP difference between the active and control arms.…”

mentioning

confidence: 98%

Elevated Blood Pressure in Acute Ischemic Stroke - Treat or Leave?

Sharma¹

2016

Cerebrovasc Dis

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

Cited by 17 publications

References 29 publications

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

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

Early Blood Pressure Reduction in Acute Ischemic Stroke with Various Severities: A Subgroup Analysis of the CATIS Trial

Elevated Blood Pressure in Acute Ischemic Stroke - Treat or Leave?

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