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Relationship Between Therapeutic Changes in Blood Pressure and Outcomes in Acute Stroke. A Metaregression
Hypertension, 08/06/09

Geeganage CM et al. – Randomized, controlled trials of interventions that would be expected, on pharmacological grounds, to alter BP in patients within 1 week of the onset of acute ischemic or hemorrhagic stroke were sought using electronic searches. The relationship between the differences in on–treatment BP and odds ratios for outcomes was assessed using meta–regression. Although large falls or increases in BP are associated with a worse outcome, modest reductions may reduce death and combine death or dependency, although the CIs are wide and compatible with an overall benefit or hazard.

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Philip M.W. Bath, 08/07/09

We have performed a meta-regression analysis of 37 randomized controlled trials of interventions that would be expected, on pharmacological grounds, to alter BP in 9008 patients with acute stroke.1 The results revealed a U-shaped relationship between blood pressure changes and outcome; with the lowest risk of death or combined death or dependency at the end of follow-up in patients with blood pressure reductions ranged from 8-15 mmHg. Although large falls or increase in blood pressure were associated with a higher risk of poor outcomes, a modest reductions may reduce death and combined death or dependency, although confidence intervals were wide and compatible with an overall benefit or hazard. The results justify the testing of whether lowering BP is beneficial in improving functional outcome, as is being done in several large ongoing randomized controlled trials. Chamila M Geeganage and Philip MW Bath Stroke Trials Unit, University of Nottingham, Nottingham NG5 1PB, UK Correspondence to Professor Philip MW Bath, Stroke Trials Unit, University of Nottingham, Nottingham NG5 1PB, UK Email: philip.bath@nottingham.ac.uk References 1.Geeganage CM, Bath PM. Relationship between therapeutic changes in blood pressure and outcomes in acute stroke. A metaregression. Hypertension. 2009

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