More intensive versus conservative blood pressure lowering after endovascular therapy in stroke: a meta-analysis of randomised controlled trials

Naji Mansoor, Ahmed, Choudhary, Vatsalya, Mohammad Nasser, Zain, Jain, Muskan, Dayanand Sharma, Dhruvikumari, Jaramillo Villegas, Mateo, Janarthanam, Sujaritha, Ayyan, Muhammad, Ravindra Nimal, Simran, Ahmad Cheema, Huzaifa, Ehsan, Muhammad, Rehman, Muhammad Aemaz Ur, Nashwan, Abdulqadir, Dani, Sourbha S, Mansoor, Ahmed and AAA ORCA, Team 2025. More intensive versus conservative blood pressure lowering after endovascular therapy in stroke: a meta-analysis of randomised controlled trials. Blood Pressure 34 (1) , 2475314. 10.1080/08037051.2025.2475314

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Abstract

The optimum systolic blood pressure (BP) after endovascular thrombectomy for acute ischaemic stroke is uncertain. We aimed to perform an updated meta-analysis of randomised controlled trials (RCTs) to evaluate the safety and efficacy of more intensive BP management compared to less intensive BP management. We searched various electronic databases to retrieve relevant RCTs on the clinical effects of more intensive BP management after endovascular thrombectomy compared to the less intensive management. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for dichotomous outcomes. Our meta-analysis included four RCTs with a total of 1560 patients. More intensive BP management (<140 mmHg) was associated with a statistically significant decrease in the number of patients showing functional independence (modified Rankin scale [mRS] score = 0-2) at 90 days (OR 0.69; CI = 0.51-0.94). Regarding 90-day mortality, our pooled results showed no statistically significant difference between the two groups (OR 1.21; CI = 0.89-1.65). There was no statistically significant difference between the two groups regarding the incidence of intracerebral haemorrhage (ICH) (OR 1.09; CI = 0.85-1.39) and the incidence of symptomatic intracerebral haemorrhage (sICH) (OR 1.11; CI = 0.75-1.65). According to our meta-analysis, the intensive BP lowering group decreased the number of patients showing functional independence at 90 days. We found no benefit of the intensive lowering of BP on mortality rates and incidence of ICH compared to the conservative BP management. Future large-scale trials should focus on other interventions to improve prognosis in these patients.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Publisher:	Taylor and Francis Group
ISSN:	0803-7051
Date of First Compliant Deposit:	20 March 2025
Date of Acceptance:	30 January 2025
Last Modified:	20 Mar 2025 16:15
URI:	https://orca.cardiff.ac.uk/id/eprint/177035

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