Kumar Karmani Vikash, Mashkoor Yusra, Riaz Anshahrah, Khalid Zunera, Mukesh Jeswani Bijay, Jawed Inshal, Khan Hina, Chowdary Mallipeddi Mohitha, Chavan Manisha, Singh Ajay, Zafar Shahzad
Department of Internal Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan.
Department of Internal Medicine, Dow University of Health Science, Karachi, Sindh, Pakistan.
Qatar Med J. 2025 Jan 27;2025(1):21. doi: 10.5339/qmj.2025.21. eCollection 2025.
This systematic review and meta-analysis examines the impact of intensive versus standard blood pressure control following post-endovascular therapy in ischemic stroke patients.
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.
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).
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.
本系统评价和荟萃分析探讨了缺血性中风患者血管内治疗后强化血压控制与标准血压控制的影响。
我们按照PRISMA（系统评价和荟萃分析的首选报告项目）指南进行了系统评价和荟萃分析，通过检索PubMed、谷歌学术和Cochrane中心数据库，检索时间从建库至2023年12月。评估的结果包括症状性脑出血、功能独立性（改良Rankin量表（mRS）评分0 - 2）、死亡或残疾（mRS评分3 - 6）以及健康相关生活质量（三级欧洲五维健康量表自我报告问卷（EQ - 5D - 3L评分））。我们在所有研究中对连续结果使用了95%置信区间（CI）的标准平均差（SMD），并使用随机效应模型进行数据合成，无论异质性如何。使用I统计量评估异质性。
我们筛选了2000篇文章，纳入了四项随机对照试验（3635例患者）。与标准血压控制相比，强化血压控制对健康相关生活质量（EQ - 5D - 3L评分）的影响更大（SMD = -0.22，95% CI：-0.34至-0.11，P = 0.0002）。然而，血管内治疗后强化血压控制在36小时内并未显著降低脑出血风险（风险比（RR） = 0.91，95% CI：0.70 - 1.19，P = 0.51）。此外，在三个月时恢复功能独立性（mRS评分0 - 2）的可能性有不显著的改善（RR = 0.87，95% CI：0.73 - 1.04，P = 0.12）。而且，与标准血压控制相比，强化血压控制在3个月时死亡或残疾（mRS评分3 - 6）的风险有不显著的增加（RR = 1.18，95% CI：0.93 - 1.51，P = 0.18）。
总之，我们的研究结果表明，实施强化血压控制不会导致血管内治疗后36小时内颅内出血、功能独立性受损、残疾或死亡等不良后果风险增加。尽管在EQ - 5D - 3L评分中观察到健康相关生活质量有所下降，但与标准管理相比，强化血压控制的总体安全性表明其作为改善血管内治疗患者结局的潜在策略具有可行性。
