Blood Pressure Management in Reperfused Ischemic Stroke: A Cochrane Systematic Review and Meta-analysis
Lucia Belen Varela1, Samanta Diaz Menai2, Camila Escobar Liquitay2, Juan Pablo Rodriguez2, Mariana Burgos2, Diego Ivaldi2, Estefania Quarteroni2, Nicolas Meza3, Luis Garegnani2
1Department of Internal Medicine, Section of Neurology, University of Manitoba, 2Cochrane associated Centre UHIBA, 3Universidad de Valparaiso
Objective:
We aim to compare intensive systolic blood pressure management (ISBPM) with conventional systolic blood pressure management (CSBPM) in patients with reperfused stroke.
Background:
Stroke is a leading cause of death and disability. Guidelines recommend maintaining blood pressure (BP) below 180/105 mmHg post-reperfusion; however, lower systolic BP (<160 mmHg) may improve outcomes.
Design/Methods:
We conducted a Cochrane review (protocol https://doi.org/10.1002/14651858.CD016085), searching without a publication limit until March 2025. Included RCTs involved adults with reperfused stroke comparing ISBPM (<160 mmHg) to CSBPM (<180 mmHg). Outcomes included clinical function, quality of life, neurological and other adverse events, neurological status, all-cause mortality, and hospital stay. We assessed risk of bias using the Cochrane RoB2 tool. We performed meta-analysis using RR for dichotomous outcomes and MD or SMD for continuous outcomes. The certainty of the evidence was appraised with GRADE.
Results:
We included eight studies (4301 participants): two on thrombolysis and six on thrombectomy. Most had a low overall risk of bias. ISBPM likely results in little to no difference in functional outcome (mRS: MD 0.28, IC95% -0.2 to 0.77; RR 0.89, CI95% 0.79 to 1.00), or quality of life (SMD -0.14, IC95% -0.49 to 0.22). ISBPM probably reduces the likelihood of a favourable neurological status (RR 0.71, CI95% 0.51-1.01). ISBPM does not significantly affect neurological (RR 1.00, 0.86 to 1.16) or other adverse events (RR 1.14, CI95% 0.84 to 1.54), but probably increases mortality (RR 1.20, CI95% 1.09 to 1.32).
Conclusions:
The studies analyzed to date suggest ISBPM has little to no effect on adults' clinical function after reperfused stroke but may increase mortality. Further research is needed on the effects of ISBPM, addressing current methodological limitations.
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