Interventions for deliberately altering blood pressure in acute stroke

Area of Science:

• Neurology
• Cardiovascular Medicine
• Clinical Trials

Background:

• Uncertainty exists regarding the active management of blood pressure during the acute phase of stroke.
• This Cochrane review is an update of previous versions published in 1997, 2001, and 2008.

Purpose of the Study:

• To evaluate the clinical effectiveness of modifying blood pressure in acute stroke patients.
• To assess the impact of various vasoactive drugs on blood pressure in acute stroke.

Main Methods:

• Systematic review and meta-analysis of 26 randomized controlled trials involving 17,011 participants.
• Inclusion criteria focused on interventions altering blood pressure within one week of acute ischemic or hemorrhagic stroke.
• Data extraction and quality assessment were performed independently by two review authors.

Main Results:

• Blood pressure-lowering treatments did not reduce death or dependency across different drug classes, stroke types, or treatment timings.
• Treatment initiated within six hours of stroke showed a trend towards reducing death or dependency, but not overall death.
• Continuing pre-stroke antihypertensive treatment was associated with worse disability scores compared to temporary discontinuation.

Conclusions:

• Insufficient evidence supports improving functional outcomes by lowering blood pressure during the acute phase of stroke.
• Withholding blood pressure-lowering drugs until patients are medically and neurologically stable is a reasonable approach.
• Further research is required to identify patient subgroups who may benefit from early blood pressure intervention.