Departments of Cerebrovascular Disease (G.B.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
Institute of Primary Health Care (BIHAM), University of Bern, Switzerland (C.D.G.).
Stroke. 2021 Jun;52(6):1974-1982. doi: 10.1161/STROKEAHA.120.031945. Epub 2021 Apr 27.
Approximately 30% of ischemic strokes occur after a previous stroke or transient ischemic attack. Arterial hypertension is one of the best established risk factors for first and recurrent stroke, both ischemic and hemorrhagic. Guidelines for the secondary prevention of ischemic stroke support the use of blood pressure (BP)-lowering drugs in most patients. However, the evidence for these recommendations comes from meta-analyses that included both ischemic and hemorrhagic stroke patients, whereas these 2 conditions differ quantitatively in several aspects. With this systematic review and meta-analysis, we aimed at summarizing the current evidence on BP-lowering drugs for secondary prevention in patients with ischemic stroke or transient ischemic attack.
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to January 31, 2020. We included randomized controlled trials comparing any specific BP-lowering drug, as monotherapy or combination, with either a control or another BP-lowering drug.
Eight studies that enrolled 33 774 patients with ischemic stroke or transient ischemic attack were included in the meta-analysis. Mean follow-up was 25 months (range, 3-48). Moderate-quality evidence indicated that a subsequent stroke occurred in 7.9% (ischemic in 7.4% or hemorrhagic in 0.6%) of patients taking any type of BP-lowering drug compared with 9.7% of patients taking placebo (odds ratio, 0.79 [95% CI, 0.66-0.94]; absolute risk difference, -1.9% [95% CI, -3.1% to -0.5%]). Moderate-quality evidence indicated that mortality occurred similarly in patients taking any type of BP-lowering treatment compared with placebo, with an absolute risk of 7.3% and 7.9%, respectively (odds ratio, 1.01 [95% CI, 0.92-1.10]; absolute risk difference, 0.1% [95% CI, -0.6% to 0.7%]).
The use of BP-lowering drugs in patients with ischemic stroke or transient ischemic attack is associated with a 1.9% risk reduction of stroke but does not affect the all-cause mortality risk.
约 30%的缺血性中风发生在前一次中风或短暂性脑缺血发作之后。动脉高血压是首次和复发性中风（包括缺血性和出血性中风）的最佳确立的风险因素之一。缺血性中风二级预防指南支持大多数患者使用降压药物。然而，这些建议的证据来自包括缺血性和出血性中风患者的荟萃分析，而这两种情况在多个方面存在数量上的差异。通过这项系统评价和荟萃分析，我们旨在总结目前关于降压药物在缺血性中风或短暂性脑缺血发作患者二级预防中的证据。
我们检索了 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库，截至 2020 年 1 月 31 日。我们纳入了比较任何特定降压药物（单药或联合用药）与对照或另一种降压药物的随机对照试验。
有 8 项研究纳入了 33774 例缺血性中风或短暂性脑缺血发作患者，进行了荟萃分析。平均随访时间为 25 个月（范围为 3-48 个月）。中等质量证据表明，服用任何类型降压药物的患者中，后续中风发生率为 7.9%（缺血性中风为 7.4%，出血性中风为 0.6%），而服用安慰剂的患者中为 9.7%（比值比，0.79 [95%可信区间，0.66-0.94]；绝对风险差异，-1.9% [95%可信区间，-3.1%至-0.5%]）。中等质量证据表明，服用任何类型降压治疗的患者与安慰剂组的死亡率相似，分别为 7.3%和 7.9%（比值比，1.01 [95%可信区间，0.92-1.10]；绝对风险差异，0.1% [95%可信区间，-0.6%至 0.7%]）。
在缺血性中风或短暂性脑缺血发作患者中使用降压药物可降低 1.9%的中风风险，但不会影响全因死亡率风险。
