Abstract P013: Meta-analysis of Poor Outcomes and Permissive Hypertension after Acute Ischemic Stroke

Abstract

Background: Stroke is the leading cause of long term disability and second leading cause of death worldwide. The effectiveness of primary and secondary prevention of stroke by antihypertensive medications is well validated, however, support for permissive hypertension in the early course of acute ischemic stroke (AIS) has been questioned. Materials and methods: We searched Pubmed, Embase, and Cochrane databases to identify RCTs comparing different blood pressure reduction regimens with placebo in AIS patients within 48 hours after symptom onset and sample size of 100 or more patients. We excluded studies that do not report mortality or functional outcomes at the end of follow up. The main outcomes were all-cause mortality and death or severe morbidity which was defined as: modified Rankin Score >2 or Bartel ADL index<60, Glasgow outcome scale3, Mathew Impairment Scale <14. Relative risks (RR) and corresponding 95% confidence intervals (CI) were calculated using random-effect model. Results: In our analysis we included 20 trials involving 17,209 patients. There was no difference in all-cause mortality RR 1.04 (95% CI 0.95-1.13), p=0.4 nor in mortality or severe disability RR 1.03 (95% CI 0.99-1.08), p=0.16 between active blood pressure reduction and permissive hypertension strategy. There was no evidence of heterogeneity between studies for both outcomes I 2 =2.6% and I 2 =14.1% , p for heterogeneity =0.42 and =0.27, respectively. Conclusion: Use of antihypertensive therapy in acute period of ischemic stroke does not have an effect on disability or all-cause mortality.