Abstract
BackgroundHypertension is common after acute stroke onset. Previous studies showed controversial effects of early blood pressure (BP) lowering on stroke outcomes. The aim of this study is to assess the effects of early BP lowering on early and long-term outcomes after acute stroke.MethodsA meta-analysis was conducted with prospective randomized controlled trials assessing the effects of early BP lowering on early and long-term outcomes after acute stroke compared with placebo. Literature searching was performed in the databases from inception to December 2013. New evidence from recent trials were included. Outcomes were analyzed as early (within 30 days) and long-term (from 3 to 12 months) endpoints using summary estimates of relative risks (RR) and their 95% confidence intervals (CI) with the fixed-effect model or random-effect model.ResultsSeventeen trials providing data from 13236 patients were included. Pooled results showed that early BP lowering after acute stroke onset was associated with more death within 30 days compared with placebo (RR: 1.34 and 95% CI: 1.02, 1.74, p = 0.03). However the results showed that early BP lowering had no evident effect on early neurological deterioration, early death within 7 days, long-term death, early and long-term dependency, early and long-term combination of death or dependency, long-term stroke recurrence, long-term myocardial infarction and long-term CVE.ConclusionsThe new results lend no support to early BP lowering after acute stroke. Early BP lowering may increase death within 30 days after acute stroke.
Highlights
Elevated blood pressure (BP) is common in acute phase of stroke onset; about more than 75% of patients with acute stroke have elevated blood pressure at presentation[1,2,3]
High blood pressure in acute stroke may be accompanied by higher risk of cerebral edema[7], hemorrhagic transformation of the infarct following thrombolysis in ischemic stroke[8] or expansion of the hematoma in hemorrhagic stroke[9]
Patients were recruited into trials within 6 to 120 hours from stroke onset and the mean time to randomize to intervention ranged from 3.6 to 105.6 hours
Summary
Elevated blood pressure (BP) is common in acute phase of stroke onset; about more than 75% of patients with acute stroke have elevated blood pressure at presentation[1,2,3]. It may reflect untreated or uncontrolled hypertension before stroke, or it may relate to stress response, autonomic dysfunction or increased intracranial pressure after stroke onset[2,3]. Observation studies have found that high blood pressure in acute stroke is associated with poor short-term and long-term outcomes[2,4,5,6]. The aim of this study is to assess the effects of early BP lowering on early and long-term outcomes after acute stroke
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