Intensive Versus Conservative Blood Pressure Lowering after Endovascular Therapy in Stroke: a meta-analysis of randomized controlled trials

BackgroundThe optimum systolic blood pressure after endovascular thrombectomy for acute ischemic stroke is uncertain. We aimed to perform an updated meta-analysis of randomized controlled trials to evaluate the safety and efficacy of more intensive blood pressure management as compared to less intensive blood pressure management. MethodsWe searched various electronic databases including Embase, MEDLINE (via PubMed), and CENTRAL to retrieve relevant randomized controlled trials (RCTs) on the clinical effects of more intensive blood pressure management after endovascular thrombectomy as compared to the less intensive management. We assessed the risk of bias using the revised Cochrane "Risk of bias" tool for randomized trials (RoB 2.0), calculated risk ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CI for continuous outcomes. ResultsOur meta-analysis included 4 RCTs with a total of 1560 patients. According to our analysis, more intensive blood pressure management 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 (RR 0.81; CI = 0.72-0.91; I2 = 12%). Regarding 90-day mortality, our pooled results from three RCTs showed no statistically significant difference between the more intensive blood pressure management group and the less intensive blood pressure management group (RR 1.17; CI = 0.90-1.52; I2 = 0%). There was no statistically significant difference between the two groups regarding the incidence of intracerebral hemorrhage (ICH) (RR 1.05; CI = 0.90-1.23; I2 = 0%) and the incidence of symptomatic intracerebral hemorrhage (sICH) (RR 1.10; CI = 0.76-1.60; I2 = 0%). ConclusionAccording to our meta-analysis, no benefit of intensive lowering of blood pressure was observed in terms of functional independence at 90 days, mortality rates, and incidence of intracerebral hemorrhage. Future large-scale trials should focus on other interventions to improve prognosis in these patients.