Stroke: acute interventions to alter blood pressure had no clear effect on death.

Clinical bottom line (level 1a-)

  1. Patients with acute ischaemic or haemorrhagic stroke who were given interventions to alter blood pressure, had no clear difference in early death, than those given a control therapy.
  2. There were only 133 patients in the evaluated studies.
Blood Pressure in Acute Stroke Collaboration (BASC) : The Cochrane Library, issue 2, Oxford: Update Software 1999; 2: -
Expires December 2002

The study

Systematic review of randomised and quasi-randomised controlled trials of
  • Patients: adults with acute ischaemic or haemorrhagic stroke
  • Intervention: agents to deliberately elevate or lower blood pressure (vasoactive drugs) taken within 2 weeks of symptom onset compared with control
  • Outcome: early death (within 1 month)


    • Articles found in ?language using Cochrane Stroke Group trials register, the Ottawa Stroke Trials Registry (1994), MEDLINE, EMBASE, ISI, from 1965 (search terms: not stated ) and searching existing review articles, contacted researchers in the field and pharmaceutical companies.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: studies comparing the investigative agents compared with other therapies or included patients with subarachnoid haemorrhage.

    Three trials involving 133 patients were included.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN?
    (% CI)
    early death 1 months /
    (%)    		 0.65
    (0.17 to 2.45)

    Comments

    1. This overview is based on only 133 patients, and concentrated on studies where blood pressure changes were specifically sought. No conclusions can be drawn one way or the other about effectiveness. Much more data (11 500 patients) are available from studies where blood pressure was lowered, but the trial was of a drug with other potential mechanisms of action (a somewhat fine distinction, it must be said). These included calcium channel blockers and beta blockers. No drug class convincingly improved outcomes.
    2. Blood pressure should be reduced if there is hypertensive encephalopathy, or an independent non-cerebral indication. Some doctors will feel uneasy about systolic pressures over 200mmHg, and will give antihypertensive therapy. The risks of too rapid or too vigorous reduction are well described, however, and any reduction should be slow and modest in extent (certainly no lower than 160mmHg in the first few days). After two weeks raised blood pressure should be lowered as part of secondary prevention.

    Citation

    1. Blood Pressure in Acute Stroke Collaboration (BASC) , : Interventions for deliberately altering blood pressure in acute stroke. The Cochrane Library, issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer: Rowan Harwood

    Clinical Question.
    Patient acute ischaemic or haemorrhagic stroke
    Intervention or Exposure vasoactive drugs
    Comparison control
    Outcome death