title: Continuing or Temporarily Stopping Prestroke Antihypertensive Medication in Acute Stroke: An Individual Patient Data Meta-Analysis.
abstract: Over 50% of patients are already taking blood pressure-lowering therapy on hospital admission for acute stroke. An individual patient data meta-analysis from randomized controlled trials was undertaken to determine the effect of continuation versus temporarily stopping preexisting antihypertensive medication in acute stroke. Key databases were searched for trials against the following inclusion criteria: randomized design; stroke onset ≤48 hours; investigating the effect of continuation versus stopping prestroke antihypertensive medication; and follow-up of ≥2 weeks. Two randomized controlled trials were identified and included in this meta-analysis of individual patient data from 2860 patients with ≤48 hours of acute stroke. Risk of bias in each study was low. In adjusted logistic regression and multiple regression analyses (using random effects), we found no significant association between continuation of prestroke antihypertensive therapy (versus stopping) and risk of death or dependency at final follow-up: odds ratio 0.96 (95% confidence interval, 0.80-1.14). No significant associations were found between continuation (versus stopping) of therapy and secondary outcomes at final follow-up. Analyses for death and dependency in prespecified subgroups revealed no significant associations with continuation versus temporarily stopping therapy, with the exception of patients randomized ≤12 hours, in whom a difference favoring stopping treatment met statistical significance. We found no significant benefit with continuation of antihypertensive treatment in the acute stroke period. Therefore, there is no urgency to administer preexisting antihypertensive therapy in the first few hours or days after stroke, unless indicated for other comorbid conditions.
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Woodhouse
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: Lisa
authors.initials: L
authors.lastname: Manning
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: Eivind
authors.initials: E
authors.lastname: Berge
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: Nikola
authors.initials: N
authors.lastname: Sprigg
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: Joanna
authors.initials: J
authors.lastname: Wardlaw
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.). philip.bath@nottingham.ac.uk.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Bath
authors.affiliation: From the Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, United Kingdom (L.J.W., N.S., P.M.B.); University Hospitals of Leicester NHS Trust, United Kingdom (L.M.); Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norfolk, United Kingdom (J.F.P.); Department of Internal Medicine, Oslo University Hospital, Norway (E.B.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (J.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); and Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, United Kingdom (T.G.R.).
authors.forename: Thompson G
authors.initials: TG
authors.lastname: Robinson
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D020521:Stroke / Q000503:physiopathology*; D013997:Time Factors; D028761:Withholding Treatment
chemical_list: D000959:Antihypertensive Agents
keywords: atrial fibrillation; blood pressure; comorbidity; hypertension; stroke