Pre-hospital blood pressure lowering in presumed hyperacute stroke: A systematic review and meta-analysis of randomized controlled trials

IF 2 4区医学 Q3 NEUROSCIENCES Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-02-01 DOI:10.1016/j.jstrokecerebrovasdis.2024.108158

Ahmed A. Ibrahim , Yehya Khlidj , Ahmed Mazen Amin , Mohamed Saad Rakab , AlMothana Manasrah , Abdelrahman Mahmoud , Muhammad Imran , Ahmed Gaber Emara , Mohamed Abuelazm

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Abstract

Background

High blood pressure (BP) is common in acute stroke and a predictor of poor outcomes. Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. We aimed to assess whether patients with presumed acute stroke benefit from pre-hospital BP lowering.

Methods

We conducted a comprehensive systematic review and meta-analysis of randomized controlled trials from PubMed, Web of Science, Scopus, and Cochrane searches until June 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). PROSPERO ID: CRD42024560200.

Results

Our analysis included five RCTs encompassing 3,933 patients. There was no difference between early BP control and usual care regarding National Institutes of Health Stroke Scale (NIHSS) after 24 hours (MD: 0.65 with 95% CI [0.01, 1.29], P = 0.05), excellent neurological recovery (Modified Rankin Score (mRS) 0–1) (RR: 1.00 with 95% CI [0.91, 1.11], P= 0.98), functional independence (mRS 0–2) (RR: 1.04 with 95% CI [0.96, 1.13], P= 0.30), and independent Ambulation (mRS 0–3) (RR: 1.01 with 95% CI [0.95, 1.06], P= 0.84). Also, there was no difference between both groups in poor neurological recovery (mRS 4–6) (RR: 0.98 with 95% CI [0.91, 1.07], P= 0.68), all-cause mortality (RR: 1.02 with 95% CI [0.90, 1.15], P= 0.79), and any serious adverse events (RR: 1.04 with 95% CI [0.95, 1.15], P= 0.40). However, early BP control significantly increased the incidence of hypotension (RR: 2.24 with 95% CI [1.14, 4.38], P= 0.02) and headache (RR: 1.51 with 95% CI [1.01, 2.26], P= 0.04).

Conclusion

In patients with presumed hyperacute stroke and elevated blood pressure, the rapid initiation of blood pressure reduction in the ambulance very early after symptom onset had no significant benefit regarding functional outcomes in patients with undifferentiated stroke but with an increased incidence of hypotension and headaches.

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假定的超急性卒中的院前血压降低：随机对照试验的系统回顾和荟萃分析

背景：高血压（BP）在急性卒中中很常见，是预后不良的预测因子。在区分出血性和缺血性中风之前，急性中风的治疗是具有挑战性的。我们的目的是评估急性卒中患者是否从院前降压中获益。方法：我们对PubMed、Web of Science、Scopus和Cochrane搜索到2024年6月的随机对照试验进行了全面的系统评价和荟萃分析。二分类数据采用风险比（RR）合并，连续数据采用均值差（MD）合并，均为95%置信区间（CI），采用（R版本4.3）。普洛斯彼罗id: CRD42024560200。结果：我们的分析包括5项随机对照试验，共3933例患者。在24小时后美国国立卫生研究院卒中量表（NIHSS）（MD: 0.65, 95% CI [0.01, 1.29], P = 0.05）、良好的神经恢复（修正Rankin评分（mRS） 0-1）（RR: 1.00, 95% CI [0.91, 1.11]， P= 0.98）、功能独立性（mRS 0-2）（RR: 1.04, 95% CI [0.96, 1.13]， P= 0.30）和独立行走（mRS 0-3）（RR: 1.01, 95% CI [0.95, 1.06]， P= 0.84）方面，早期血压控制与常规护理之间无差异。此外，两组在神经恢复不良（mRS 4-6）（RR: 0.98, 95% CI [0.91, 1.07]， P= 0.68）、全因死亡率（RR: 1.02, 95% CI [0.90, 1.15]， P= 0.79）和任何严重不良事件（RR: 1.04, 95% CI [0.95, 1.15]， P= 0.40）方面均无差异。然而，早期血压控制显著增加了低血压（RR: 2.24, 95% CI [1.14, 4.38]， P= 0.02）和头痛（RR: 1.51, 95% CI [1.01, 2.26]， P= 0.04）的发生率。结论：在假定为超急性卒中和血压升高的患者中，在症状出现后很早就在救护车上快速开始降压对未分化卒中患者的功能结局没有显著益处，但会增加低血压和头痛的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.