Vasoactive Drugs for Acute Ischaemic Stroke

Beta receptor antagonists, calcium channel blockers, nitric oxide, and prostacyclin lower BP in acute stroke. However, these data do not allow the effect of changing BP on outcome to be assessed. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 43 RCTs with a total of 7649 subjects. The patients had suffered of acute ischemic stroke within one week prior to the study entry. One trial studied acute cerebral haemorrhage (n=404). Nine studies included patients who were hypertensive at the time of recruitment, the other studies involved patients with a range of blood pressure (BP). Among BP-lowering trials, beta receptor antagonists lowered BP (early systolic BP (SBP) mean difference (MD) -6.1 mmHg, 95% CI -11.4 to -0.9; late SBP MD -4.9 mmHg, 95% CI -10.2 to 0.4; late diastolic BP (DBP) MD -4.5 mmHg, 95% CI -7.8 to -1.2). Oral calcium channel blockers (CCB) lowered BP (late SBP MD -3.2 mmHg, 95% CI -5.4 to -1.1; early DBP MD -2.5, 95% CI -5.6 to 0.7; late DBP MD -2.1, 95% CI -3.5 to -0.7). Nitric oxide donors lowered BP (early SBP MD -10.3 mmHg, 95% CI -17.6 to -3.0). Prostacyclin lowered BP (late SBP MD, -7.7 mmHg, 95% CI -15.6 to 0.2; late DBP MD -3.9 mmHg, 95% CI -8.1 to 0.4). Among BP-increasing trials, diaspirin cross-linked haemoglobin (DCLHb) increased BP (early SBP MD 15.3 mmHg, 95% CI 4.0 to 26.6; late SBP MD 15.9 mmHg, 95% CI 1.8 to 30.0). None of the BP-lowering drugs significantly altered outcome (death). DCLHb increased combined death or dependency (OR 5.41, 95% CI 1.87 to 15.64). The numbers of trials and participants with data on BP and outcome were not identical and it was not possible to relate group differences in BP with group differences in outcome. The relationship between BP and outcome could not be studied for methodological reasons.