Effects of Early Hypertension Control after Ischaemic Stroke on the Outcome: A Meta-Analysis.
BACKGROUND
Accumulating evidence suggests that high blood pressure (BP) increases the risk of cerebral oedema and haemorrhagic transformation of the ischaemic stroke (IS), and that low BP in acute ischaemic stroke (AIS) is associated with a poor prognosis. The best possible management of hypertension after AIS is still uncertain.


METHODS
English databases were searched to identify relevant randomized controlled trials assessing the effects of early BP lowering (started within the first 48 h) after IS on outcome from January 1990 to August 2015. We set strict inclusion criteria and used the Review Manager 5.2 software from Cochrane Collaboration to calculate the combined risk ratio (RR).


RESULTS
Eight studies met our criteria. Early BP lowering after AIS did not significantly affect the risk of early and long-term death (RR 1.22; 95% CI 0.69-2.16 and RR 1.03; 95% CI 0.62-1.71), early and long-term dependency (RR 1.02; 95% CI 0.94-1.10 and RR 1.07; 95% CI 0.84-1.36), early and long-term death or dependency (RR 1.04; 95% CI 0.94-1.19 and RR 1.00; 95% CI 0.95-1.05), long-term stroke recurrence (RR 0.74; 95% CI 0.49-1.11), long-term myocardial infarction (RR 0.99; 95% CI 0.27-3.61), and long-term vascular events (RR 0.97; 95% CI 0.72-1.31).


CONCLUSIONS
Our results revealed neither support nor opposition to early BP lowering (started within 48 h) after AIS; individualized BP management based on the patients' condition may be a good choice.
Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China.
Shuping
S
Liu
Chengyan
C
Li
Tao
T
Li
Jing
J
Xiong
Xueqing
X
Zhao
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012107:Research Design; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents