Prehospital blood pressure lowering in patients with ultra-acute presumed stroke: A systematic review and meta-analysis

Objective High blood pressure frequently occurs in the setting of acute stroke and is associated with worse prognoses. However, it is still uncertain whether initiating blood pressure-lowering therapy in the prehospital phase after stroke onset can enhance outcomes for patients with undifferentiated acute stroke. Methods We conducted a search of the PubMed, Embase, and Cochrane databases to identify randomized controlled trials investigating prehospital blood pressure lowering interventions for presumed ultra-acute stroke (within <6 hours). The primary outcome analyzed was the 90-day modified Rankin Scale (mRS), while mortality was considered a secondary outcome. Results This meta-analysis included four studies with a total of 3912 patients. The pooled data revealed no significant difference in poor functional outcomes at 90 days (RR = 0.97, 95% CI: 0.92-1.02) or mortality rates (RR = 1.02, 95% CI: 0.90-1.15) between the group receiving blood pressure lowering treatment and the control or placebo group. Conclusions In patients with ultra-acute presumed stroke, prehospital blood pressure lowering treatment within 6 hours of stroke did not improve clinical outcomes (PROSPERO: CRD42024557505).