A Cochrane review [Abstract] 1 included 26 studies with a total of 17 011 subjects. The patients were enrolled within one week of acute ischaemic or haemorrhagic stroke. Most data came from trials that had a wide time window for recruitment; 4 trials gave treatment within 6 hours and one trial within 8 hours. The trials tested alpha-2 adrenergic agonists (A2AA), angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor antagonists (ARA), calcium channel blockers (CCBs), nitric oxide (NO) donors, thiazide-like diuretics and target-driven blood pressure lowering.At 24 hours after randomisation the reduction in systolic blood pressure (SBP) and diastolic blood pressure were as follow for different treatments.
Blood pressure lowering did not reduce death or dependency either by drug class (OR 0.98, 95% CI 0.92 to 1.05; 16 studies, n=15 489), stroke type (OR 0.98, 95% CI 0.92 to 1.05; 16 trials, n=15 366) or time to treatment (OR 0.98, 95% CI 0.92 to 1.05; 16 trials, n=15 489). Treatment within 6 hours of stroke appeared effective in reducing death or dependency (OR 0.86, 95% CI 0.76 to 0.99; 15 studies, n=15 520) but not death (OR 0.70, 95% CI 0.38 to 1.26; 3 studies, n=3056) at the end of the trial. Although death or dependency did not differ between people who continued pre-stroke antihypertensive treatment vs. those who stopped it temporarily (worse outcome with continuing treatment, OR 1.06, 95% CI 0.91 to 1.24; 2 studies, n=2860), disability scores at the end of the trial were worse for patients randomised to continue treatment (Barthel Index: MD -3.2, 95% CI -5.8, -0.6; 2 studies, n=2860).
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