Comparative Analysis of Intensive vs Standard Blood Pressure Targets on Mortality and Vascular Events in Hypertensive Patients with a History of Stroke: A Meta-Analysis Study

Background: This study investigates the impact of intensive versus standard blood pressure control on mortality and vascular incidents in hypertensive patients with a history of stroke. Objective: The aim is to compare these treatment approaches and understand their potential benefits and risks through a meta-analysis of existing studies. Method: A comprehensive search was conducted across multiple databases, resulting in the inclusion of 11 Randomized Controlled Trial studies and 2 prospective cohort studies. The risk of bias was assessed using RoB 2 tools and the Newcastle-Ottawa Scale. Result: Intensive blood pressure control showed a slightly higher risk of death and other vascular events compared to standard blood pressure control. Intensive blood pressure control has higher risk of death (OR: 1.11, 95% CI: 1.06 – 1.17, I2: 68%). It has a slightly lower risk of Death or Disability (OR: 0.95, 95% CI: 0.86 – 1.04, I 2 : 0%). It has a slightly higher risk of Hematoma Expansion (OR: 1.10, 95% CI: 1.01 – 1.19, I 2 : 72%). It has a slightly higher risk of recurrent stroke (OR: 1.04, 95% CI: 0.98 - 1.10, I 2 : 64%). It has a slightly higher risk of Neurological Detrioration (OR: 1.13, 95% CI: 1.05 - 1.21, I 2 : 3%). It has a lower risk of mRS score (OR: 0.86, 95% CI: 0.84 – 0.88, I 2 : 74%). It has a slightly lower risk of improvement mRS score (OR: 0.90, 95% CI: 0.87 – 0.93, I 2 : 0%). Most of the studies were conducted in multicentre regions and had large sample sizes, which signifies the external validity of this meta-analysis. Conclusion: Intensive blood pressure targets may not be more beneficial than standard ones in reducing the risk of mortality and vascular events. Further studies are needed to validate these findings.