Blood Pressure Control in Stroke | Journal Scan

Study Questions:

What is the impact of early blood pressure lowering in patients presenting with acute ischemic stroke?

Methods:

The authors conducted a meta-analysis of randomized controlled trials evaluating active blood pressure lowering in the setting of early ischemic stroke. They included randomized controlled trials in which blood pressure lowering was started within 3 days of ischemic stroke onset in the active arm. The primary outcome was unfavorable outcome at 3 months or at trial endpoint, defined as dependency or death, and the key secondary outcome was recurrent vascular events.

Results:

The analysis included 13 randomized controlled trials with 12,703 participants. Blood pressure lowering in early ischemic stroke did not affect the risk of death or dependency at 3 months or at trial endpoint (relative risk, 1.04; 95% confidence interval, 0.96-1.13; p = 0.35). Blood pressure lowering had a neutral effect on recurrent vascular events, as well as on disability or death, all-cause mortality, recurrent stroke, and serious adverse events.

Conclusions:

Among patients with ischemic stroke, early blood pressure lowering did not result in improved clinical outcomes.

Perspective:

In the past, there was considerable controversy regarding the need to treat hypertension early after ischemic stroke. There was concern that lowering blood pressure early after stroke might impact collateral flow and extend the infarct zone, while lowering blood pressure was thought to be potentially beneficial by lowering the risk of brain edema and hemorrhagic transformation. Multiple trials have suggested that there does not appear to be a neurological benefit in association with early blood pressure control, although a more recent updated meta-analysis raised concerns about increased mortality at 30 days with this approach (Wang H, et al. PLoS One 2014;9:e97917). Given the possibility of harm, and no demonstrated benefit, early blood pressure control in ischemic patients should only be used selectively.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Hypertension

Keywords: Blood Pressure, Blood Pressure Determination, Brain Edema, Hypertension, Hypotension, Ischemia, Metabolic Syndrome X, Meta-Analysis, Mortality, Risk, Secondary Prevention, Stroke, Vascular Diseases


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