Abstract 90: Meta-analysis Of Early Treatment Of Hypertension In Acute Ischemic Stroke And Functional Outcome

Abstract

Introduction: Elevation in blood pressure (BP) in the early period following acute ischemic stroke (AIS) is frequent and likely due to a physiologic response to neurologic insult, damage to specific structures, and failure of cerebral autoregulation. It remains unclear whether early treatment of elevated BP after AIS influences clinical outcome in these patients. This meta-analysis aimed to investigate if treatment of sustained elevations in BP in the early period following AIS leads to a reduced risk of poor functional outcome. Method: Systematic review identifying randomized-controlled, double-blinded trials of AIS patients between 1994-2020 comparing those who receive anti-hypertensive medications within 72 hours of symptom-onset to those who do not receive medication. The primary outcome was poor functional outcome (defined by mRS > 2 at 90 days). Results were pooled using inverse variance random effects meta-analyses. Conclusions accounted for the magnitude of effect, precision, and risk of bias in the studies using the modified GRADE process of the American Academy of Neurology (AAN). Results: Ten randomized-controlled double-blinded studies totaling 15762 AIS patients met inclusion criteria. Baseline patient characteristics were without significant confounders. Mean symptom-onset to treatment time was 3-72 hours. The duration of treatment ranged from 3-90 days. Antihypertensive medications used included calcium-channel blockers, angiotensin receptor blockers, ACE-inhibitors, nitrates, and diuretics. Overall, poor functional outcome occurred in 32.4% of patients. There was no statistical difference in poor functional outcome in patients treated with antihypertensive medications within 72 hours of symptom-onset vs no treatment (OR=1.05, CI 95% 0.93-1.18). Conclusion: For the early period following AIS, treatment of sustained elevations in BP does not reduce the risk of mRS > 2 at 90 days. Confidence in the evidence is strong, anchored by selection of large randomized-controlled, double-blinded trials. Limitations include variable BP medications, initial stroke severities, and AIS mechanisms.