Key result
Effective acute anti-hypertensive therapy within 72 hours of stroke onset had a neutral effect on death or dependency (RR 1.01) compared to control in patients with acute ischemic stroke.
Why the study?
Many studies failed to enhance blood pressure decrease after acute phase anti-hypertensive therapies, leaving the effects of effective acute anti-hypertensive therapies on ischemic stroke prognosis unclear.
Does effective acute anti-hypertensive therapy improve functional outcome or reduce mortality in ischemic stroke patients when initiated within 72 hours of onset?
Meta-Analysis (n=9,427)
Yes
Does effective acute anti-hypertensive therapy improve functional outcome or reduce mortality in ischemic stroke patients when initiated within 72 hours of onset?
Relative Risk: 1.01 (95% CI 0.96–1.08)
Effective acute anti-hypertensive therapy initiated within 72 hours of ischemic stroke onset does not improve functional outcomes, mortality, or severe adverse events.
No benefit from acute BP lowering in ischemic stroke; confirms neutral effects across 8 RCTs and supports avoiding routine use.
Abstract Background: Although multiple randomized controlled trials (RCTs) and meta-analyses have been conducted on the issue of acute phase anti-hypertensive therapies for ischemic stroke (IS) patients, many studies have failed to enhance blood pressure (BP) decrease after these treatments. The effects of effective acute anti-hypertensive therapies on IS prognosis are still unclear.Methods: Published literature was systematically searched in PubMed, Embase and Cochrane Library. Multiple RCTs that included IS patients, in which there was a significant BP decrease in the anti-hypertensive intervention group compared with the control group within 72 h after the onset of stroke, were identified. A meta-analysis was conducted to assess the effects of such therapy on the functional outcome, mortality, and multiple severe adverse events (SAEs) of IS patients.Results: Eight RCTs were included in this study, with a total of 9427 IS patients. According to this meta-analysis, with significant BP differences between the treatment and control groups within 72 h from stroke onset, effective acute anti-hypertensive therapy has a neutral effect on multiple IS prognostic factors, including functional outcome (RR 1.03, 95% CI 0.93-1.13), mortality (RR 1.10, 95% CI 0.89-1.35), and multiple SAEs.Conclusions: Based on current studies, effective acute anti-hypertensive therapy did not improve the prognosis of IS patients, including functional outcome, mortality, and SAEs. There is no evidence that such therapy is beneficial in clinical practice.
No takes yet. Share an insight, caveat, or question.
Li et al. (2020) conducted a meta-analysis in Acute ischemic stroke (n=9,427). Acute anti-hypertensive therapy vs. Control (placebo, no treatment, or guideline-recommended therapy) was evaluated on Death or dependency at follow-up endpoint (RR 1.01, 95% CI 0.96-1.08). Effective acute anti-hypertensive therapy within 72 hours of stroke onset had a neutral effect on death or dependency (RR 1.01) compared to control in patients with acute ischemic stroke.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: