Abstract Details

Title Blood Pressure Management in Reperfused Ischemic Stroke: A Cochrane Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-005

Objective

We aim to compare intensive systolic blood pressure management (ISBPM) with conventional systolic blood pressure management (CSBPM) in patients with reperfused stroke.

Background Stroke is a leading cause of death and disability. Guidelines recommend maintaining blood pressure (BP) below 180/105 mmHg post-reperfusion; however, lower systolic BP (<160 mmHg) may improve outcomes.

Design/Methods We conducted a Cochrane review (protocol https://doi.org/10.1002/14651858.CD016085), searching without a publication limit until March 2025. Included RCTs involved adults with reperfused stroke comparing ISBPM (<160 mmHg) to CSBPM (<180 mmHg). Outcomes included clinical function, quality of life, neurological and other adverse events, neurological status, all-cause mortality, and hospital stay. We assessed risk of bias using the Cochrane RoB2 tool. We performed meta-analysis using RR for dichotomous outcomes and MD or SMD for continuous outcomes. The certainty of the evidence was appraised with GRADE.

Results We included eight studies (4301 participants): two on thrombolysis and six on thrombectomy. Most had a low overall risk of bias. ISBPM likely results in little to no difference in functional outcome (mRS: MD 0.28, IC95% -0.2 to 0.77; RR 0.89, CI95% 0.79 to 1.00), or quality of life (SMD -0.14, IC95% -0.49 to 0.22). ISBPM probably reduces the likelihood of a favourable neurological status (RR 0.71, CI95% 0.51-1.01). ISBPM does not significantly affect neurological (RR 1.00, 0.86 to 1.16) or other adverse events (RR 1.14, CI95% 0.84 to 1.54), but probably increases mortality (RR 1.20, CI95% 1.09 to 1.32).

Conclusions The studies analyzed to date suggest ISBPM has little to no effect on adults' clinical function after reperfused stroke but may increase mortality. Further research is needed on the effects of ISBPM, addressing current methodological limitations.

Authors/Disclosures
Lucia Belen Varela PRESENTER	Lucia Belen Varela has nothing to disclose.
samanta diaz menai, MD	Ms. diaz menai has nothing to disclose.
Camila M. Escobar, Sr., MD	Miss Escobar has nothing to disclose.
Juan P. Rodriguez, MD	Dr. Rodriguez has nothing to disclose.
Amanda Burgos, MS	Ms. Burgos has nothing to disclose.
Diego Ivaldi, PT	Mr. Ivaldi has nothing to disclose.
Estefanía Quarteroni, Sr., PT	Mrs. Quarteroni has nothing to disclose.
Nicolas Meza, MD	Mr. Meza has nothing to disclose.
Luis Garegnani, PhD, PT	Prof. Garegnani has nothing to disclose.

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