Exploring the impact of intensive versus standard blood pressure management following post-endovascular therapy in ischemic stroke: A comparative systematic review and meta-analysis.

OBJECTIVE

This systematic review and meta-analysis examines the impact of intensive versus standard blood pressure control following post-endovascular therapy in ischemic stroke patients.

METHODS

We conducted a systematic review and meta-analysis in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, Google Scholar, and Cochrane Central databases from inception to December 2023. The outcomes evaluated included symptomatic intracerebral hemorrhage, functional independence (modified Rankin Scale (mRS) score 0-2), death or disability (mRS score 3-6), and health-related quality of life (three-level EuroQoL five-dimensional self-report questionnaire (EQ-5D-3L score). We used the standard mean difference (SMD) with a 95% confidence interval (CI) for continuous outcomes in all studies and used a random-effects model for data synthesis irrespective of heterogeneity. Heterogeneity was assessed using the I statistics.

RESULTS

We screened 2,000 articles and included four randomized controlled trials (3,635 patients). Intensive blood pressure control affected the health-related quality of life (EQ-5D-3L score) more than standard blood pressure (SMD = -0.22, 95% CI: -0.34 to -0.11,  = 0.0002). However, intensive blood pressure control after endovascular therapy did not significantly reduce the risk of intracerebral hemorrhage within 36 hours (risk ratio (RR) = 0.91, 95% CI: 0.70-1.19,  = 0.51). Additionally, there was an insignificant improvement in the likelihood of regaining functional independence (mRS score 0-2) at three months (RR = 0.87, 95% CI: 0.73-1.04,  = 0.12). Moreover, there was an insignificant increase in the risk of death or disability (mRS score 3-6) at 3 months with intensive blood pressure control compared to standard blood pressure control (RR = 1.18, 95% CI: 0.93-1.51,  = 0.18).

CONCLUSION

In summary, our findings indicate that implementing intensive blood pressure control does not lead to an increased risk of adverse outcomes such as intracranial hemorrhage within 36 hours, compromised functional independence, disability, or mortality 3 months following endovascular therapy. Despite the observed reduction in health-related quality of life reflected in the EQ-5D-3L score, the overall safety profile of intensive blood pressure control compared to standard management suggests its viability as a potential strategy for improving patient outcomes in the context of endovascular therapy.