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Cochrane Database of Systematic Reviews

急性脳卒中における意図的な血圧変化のための介入

Información

DOI:
https://doi.org/10.1002/14651858.CD000039.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 28 octubre 2014see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Accidentes cerebrovasculares

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Philip MW Bath

    Correspondencia a: Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK

    [email protected]

  • Kailash Krishnan

    Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK

Contributions of authors

PMW Bath was involved with the design, development of search strategies, analysis and writing. He is the study guarantor.
K Krishnan was involved with searches for studies, input of data into the latest version, analysis of the latest version, and writing.

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • South Thames NHS Executive (1995‐1997), UK.

  • Wolfson Foundation (1993‐1998), UK.

  • Trent NHS Executive (1998‐2000), UK.

  • The Stroke Association (1998‐2015), UK.

  • Medical Research Council (2006‐2014), UK.

  • British Heart Foundation (2006‐2008), UK.

Declarations of interest

PMWB was involved with eight completed trials (Bath 2000; Rashid 2003 5 mg/Rashid 2003 5/10 mg/Rashid 2003 10 mg; Willmot 2006; PRoFESS 2009; SCAST 2011; RIGHT 2013; TAST 2013; ENOS 2014), each of which are included in this review.

Acknowledgements

Data collation and analysis, and review writing for this version of the review: K Krishnan, PMW Bath.

Trialists:

  • DR Lisk, JC Grotta: (summary and individual data) (Lisk 1993).

  • N Uzuner: (summary and individual data) (Uzuner 1995).

  • AG Dyker, K Lees: (summary and individual patient data) (Dyker 1997).

  • PMW Bath: (summary and individual patient data) (Bath 2000; Rashid 2003 10 mg; Rashid 2003 5/10 mg; Rashid 2003 5 mg; Willmot 2006; RIGHT 2013; TAST 2013; ENOS 2014).

  • AB Hillis: (summary data) (Hillis 2003).

  • D Eveson: (summary data) (Eveson 2007).

  • FJ Bath‐Hextall was a co‐author involved with the following aspects of the first version of the review: design, development of search strategies, carrying out searches, input of data, analysis, and writing.

  • The late C Geeganage was a co‐author involved with the following aspects of the second version of the review: development of search strategies, carrying out searches, input of data, analysis, and writing.

We are grateful to the Editorial Board of the Cochrane Stroke Group and external peer reviewers for commenting on this review. All the analyses and their interpretation reflect the opinions of the authors; no pharmaceutical company was involved in this review.

Version history

Published

Title

Stage

Authors

Version

2014 Oct 28

Interventions for deliberately altering blood pressure in acute stroke

Review

Philip MW Bath, Kailash Krishnan

https://doi.org/10.1002/14651858.CD000039.pub3

2008 Oct 08

Interventions for deliberately altering blood pressure in acute stroke

Review

Chamila Geeganage, Philip MW Bath

https://doi.org/10.1002/14651858.CD000039.pub2

2001 Jul 23

Interventions for deliberately altering blood pressure in acute stroke

Review

( BASC) Blood pressure in Acute Stroke Collaboration, Philip MW Bath, Fiona J Bath‐Hextall

https://doi.org/10.1002/14651858.CD000039

Differences between protocol and review

None relevant.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Funnel plot of comparison: 1 Blood pressure lowering therapy in acute stroke, outcome: 1.1 Death or dependency, end of trial by intervention.
Figuras y tablas -
Figure 1

Funnel plot of comparison: 1 Blood pressure lowering therapy in acute stroke, outcome: 1.1 Death or dependency, end of trial by intervention.

Funnel plot of comparison: 1 Blood pressure lowering therapy in acute stroke, outcome: 1.23 SBP, first after randomisation, by intervention.
Figuras y tablas -
Figure 2

Funnel plot of comparison: 1 Blood pressure lowering therapy in acute stroke, outcome: 1.23 SBP, first after randomisation, by intervention.

Results of database search
Figuras y tablas -
Figure 3

Results of database search

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 1 Death or dependency, end of trial by intervention.
Figuras y tablas -
Analysis 1.1

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 1 Death or dependency, end of trial by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 2 Death or dependency, end of trial by stroke type.
Figuras y tablas -
Analysis 1.2

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 2 Death or dependency, end of trial by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 3 Death or dependency, end of trial by stroke location.
Figuras y tablas -
Analysis 1.3

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 3 Death or dependency, end of trial by stroke location.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 4 Death or dependency, end of trial by time to treatment.
Figuras y tablas -
Analysis 1.4

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 4 Death or dependency, end of trial by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 5 Death, early by intervention.
Figuras y tablas -
Analysis 1.5

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 5 Death, early by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 6 Death, early by stroke type.
Figuras y tablas -
Analysis 1.6

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 6 Death, early by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 7 Death, early by time to treatment.
Figuras y tablas -
Analysis 1.7

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 7 Death, early by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 8 Death, end of trial by intervention.
Figuras y tablas -
Analysis 1.8

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 8 Death, end of trial by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 9 Death, end of trial by stroke type.
Figuras y tablas -
Analysis 1.9

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 9 Death, end of trial by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 10 Death, end of trial by time to treatment.
Figuras y tablas -
Analysis 1.10

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 10 Death, end of trial by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 11 Barthel Index, end of trial, by intervention.
Figuras y tablas -
Analysis 1.11

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 11 Barthel Index, end of trial, by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 12 Barthel Index, end of trial, by stroke type.
Figuras y tablas -
Analysis 1.12

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 12 Barthel Index, end of trial, by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 13 Barthel Index, end of trial, by time to treatment.
Figuras y tablas -
Analysis 1.13

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 13 Barthel Index, end of trial, by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 14 Early neurological deterioration, by intervention.
Figuras y tablas -
Analysis 1.14

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 14 Early neurological deterioration, by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 15 Early neurological deterioration, by stroke type.
Figuras y tablas -
Analysis 1.15

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 15 Early neurological deterioration, by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 16 Early neurological deterioration, by time to treatment.
Figuras y tablas -
Analysis 1.16

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 16 Early neurological deterioration, by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 17 Quality of life (EuroQol) at end of trial, by intervention.
Figuras y tablas -
Analysis 1.17

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 17 Quality of life (EuroQol) at end of trial, by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 18 Quality of life (EuroQoL) at end of trial, by stroke type.
Figuras y tablas -
Analysis 1.18

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 18 Quality of life (EuroQoL) at end of trial, by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 19 Quality of life (EuroQoL) at end of trial, by time to treatment.
Figuras y tablas -
Analysis 1.19

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 19 Quality of life (EuroQoL) at end of trial, by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 20 Length of stay, by intervention.
Figuras y tablas -
Analysis 1.20

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 20 Length of stay, by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 21 Length of stay, by stroke type.
Figuras y tablas -
Analysis 1.21

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 21 Length of stay, by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 22 Length of stay, by time to treatment.
Figuras y tablas -
Analysis 1.22

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 22 Length of stay, by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 23 SBP, first after randomisation, by intervention.
Figuras y tablas -
Analysis 1.23

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 23 SBP, first after randomisation, by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 24 SBP, first after randomisation by stroke type.
Figuras y tablas -
Analysis 1.24

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 24 SBP, first after randomisation by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 25 SBP, first after randomisation by time to treatment.
Figuras y tablas -
Analysis 1.25

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 25 SBP, first after randomisation by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 26 SBP, at day 1.
Figuras y tablas -
Analysis 1.26

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 26 SBP, at day 1.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 27 SBP, at day 7.
Figuras y tablas -
Analysis 1.27

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 27 SBP, at day 7.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 28 SBP, at end of treatment.
Figuras y tablas -
Analysis 1.28

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 28 SBP, at end of treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 29 DBP, first after randomisation by intervention.
Figuras y tablas -
Analysis 1.29

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 29 DBP, first after randomisation by intervention.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 30 DBP, first after randomisation by stroke type.
Figuras y tablas -
Analysis 1.30

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 30 DBP, first after randomisation by stroke type.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 31 DBP, first after randomisation by time to treatment.
Figuras y tablas -
Analysis 1.31

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 31 DBP, first after randomisation by time to treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 32 DBP, at day 1.
Figuras y tablas -
Analysis 1.32

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 32 DBP, at day 1.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 33 DBP, at day 7.
Figuras y tablas -
Analysis 1.33

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 33 DBP, at day 7.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 34 DBP, at end of treatment.
Figuras y tablas -
Analysis 1.34

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 34 DBP, at end of treatment.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 35 HR at baseline.
Figuras y tablas -
Analysis 1.35

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 35 HR at baseline.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 36 HR, first after randomisation.
Figuras y tablas -
Analysis 1.36

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 36 HR, first after randomisation.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 37 HR, at day 1.
Figuras y tablas -
Analysis 1.37

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 37 HR, at day 1.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 38 HR, at day 7.
Figuras y tablas -
Analysis 1.38

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 38 HR, at day 7.

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 39 HR, at end of treatment.
Figuras y tablas -
Analysis 1.39

Comparison 1 Blood pressure lowering therapy in acute stroke, Outcome 39 HR, at end of treatment.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 1 Death or dependency, end of trial by C/S.
Figuras y tablas -
Analysis 2.1

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 1 Death or dependency, end of trial by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 2 Death or dependency, end of trial by stroke type C/S.
Figuras y tablas -
Analysis 2.2

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 2 Death or dependency, end of trial by stroke type C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 3 Death or dependency, end of trial by time to treatment.
Figuras y tablas -
Analysis 2.3

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 3 Death or dependency, end of trial by time to treatment.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 4 Death early, by C/S.
Figuras y tablas -
Analysis 2.4

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 4 Death early, by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 5 Death early, by stroke type C/S.
Figuras y tablas -
Analysis 2.5

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 5 Death early, by stroke type C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 6 Death early, by time to treatment C/S.
Figuras y tablas -
Analysis 2.6

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 6 Death early, by time to treatment C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 7 Death, end of trial by C/S.
Figuras y tablas -
Analysis 2.7

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 7 Death, end of trial by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 8 Death end of trial, by stroke type C/S.
Figuras y tablas -
Analysis 2.8

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 8 Death end of trial, by stroke type C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 9 Death, end of trial by time to treatment C/S.
Figuras y tablas -
Analysis 2.9

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 9 Death, end of trial by time to treatment C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 10 Barthel Index, end of trial, by C/S.
Figuras y tablas -
Analysis 2.10

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 10 Barthel Index, end of trial, by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 11 Early neurological deterioration, by C/S.
Figuras y tablas -
Analysis 2.11

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 11 Early neurological deterioration, by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 12 Quality of life (EuroQol) at end of trial, by C/S.
Figuras y tablas -
Analysis 2.12

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 12 Quality of life (EuroQol) at end of trial, by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 13 Length of stay, by C/S.
Figuras y tablas -
Analysis 2.13

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 13 Length of stay, by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 14 SBP, first after randomisation, by C/S.
Figuras y tablas -
Analysis 2.14

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 14 SBP, first after randomisation, by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 15 SBP, at day 1 by C/S.
Figuras y tablas -
Analysis 2.15

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 15 SBP, at day 1 by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 16 SBP, at end of treatment by C/S.
Figuras y tablas -
Analysis 2.16

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 16 SBP, at end of treatment by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 17 DBP, at baseline by C/S.
Figuras y tablas -
Analysis 2.17

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 17 DBP, at baseline by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 18 DBP at day 1, by C/S.
Figuras y tablas -
Analysis 2.18

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 18 DBP at day 1, by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 19 DBP, at end of treatment by C/S.
Figuras y tablas -
Analysis 2.19

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 19 DBP, at end of treatment by C/S.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 20 HR, at day 1.
Figuras y tablas -
Analysis 2.20

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 20 HR, at day 1.

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 21 HR, at end of treatment.
Figuras y tablas -
Analysis 2.21

Comparison 2 Blood pressure altering by continue or stop prestroke antihypertensives (C/S), Outcome 21 HR, at end of treatment.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 1 Death early, by intervention.
Figuras y tablas -
Analysis 3.1

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 1 Death early, by intervention.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 2 Death early, by stroke type.
Figuras y tablas -
Analysis 3.2

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 2 Death early, by stroke type.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 3 Death end of trial, by intervention.
Figuras y tablas -
Analysis 3.3

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 3 Death end of trial, by intervention.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 4 SBP, at baseline.
Figuras y tablas -
Analysis 3.4

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 4 SBP, at baseline.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 5 SBP, first after randomisation.
Figuras y tablas -
Analysis 3.5

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 5 SBP, first after randomisation.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 6 SBP, at day 1.
Figuras y tablas -
Analysis 3.6

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 6 SBP, at day 1.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 7 DBP, at baseline.
Figuras y tablas -
Analysis 3.7

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 7 DBP, at baseline.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 8 DBP, first after randomisation.
Figuras y tablas -
Analysis 3.8

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 8 DBP, first after randomisation.

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 9 DBP, at day 1.
Figuras y tablas -
Analysis 3.9

Comparison 3 Blood pressure elevation therapy in acute stroke, Outcome 9 DBP, at day 1.

Table 1. Blood pressure changes after first dose

Type

Trials

Participants

SBP

95% CI

I2 %

DBP

95% CI

I2%

Type of intervention

ACE‐I, oral

5

123

‐13.7

‐20.0 to ‐7.3

0

‐4.2

‐9.7 to 1.2

16

ACE‐I, sublingual

1

42

‐6.0

‐17.6 to 5.6

+2.2

‐5.5 to 9.9

ARA

3

3408

‐4.6

‐8 to ‐1

74

‐2.5

‐4.3 to ‐0.6

67

α‐2 adrenoceptor agonist

1

4

‐13.7

‐41.5 to 14.1

‐2.1

‐15.4 to 11.2

ß‐receptor antagonist, oral

1

44

‐11.5

‐20.3 to ‐2.7

‐5.4

‐13 to 2.2

ß‐receptor antagonist, iv

1

41

‐16.4

‐27.4 to ‐5.4

‐17.5

‐25.3 to ‐9.7

Calcium channel blocker, oral

3

106

‐7.6

‐17.2 to 1.9

0

‐3.3

‐9.3 to 2.7

Calcium channel blocker, iv

1

11

‐9.7

‐24.4 to 4.9

‐12.9

‐31.4 to 5.6

Nitric oxide donor

5

4192

‐9.3

‐14.5 to ‐4

26

‐3.6

‐4.4 to ‐2.8

0

Diuretic, thiazide‐like

1

40

‐20.0

‐38.6 to ‐1.4

Low BP target

5

7421

‐11.4

‐15.3 to ‐7.5

93

‐6.9

‐15.7 to 1.9

94

Overall

27

15432

‐11.2

‐13.7, ‐8.7

86

‐3.9

‐5.4 to ‐2.6

61

ACE‐I: angiotensin converting enzyme inhibitors
ARA: angiotensin receptor antagonist
BP: blood pressure
DBP: diastolic blood pressure
SBP: systolic blood pressure
iv: intravenous

Figuras y tablas -
Table 1. Blood pressure changes after first dose
Table 2. Blood pressure changes by type of intervention

SBP

First

Day 1

Day 7

Type of intervention

ACE‐I, oral

‐21.0

‐7.9

‐26

ACE‐I, sublingual

‐6.0

‐12

Angiotensin receptor antagonist

‐4.6

‐0.5

‐6

Alpha‐2 adrenoceptor agonist

‐13.7

‐21.8

Beta‐receptor antagonist, oral

‐11.5

‐14

Beta‐receptor antagonist, iv

‐16.4

‐5

Calcium channel blocker, oral

‐7.6

‐13.2

Calcium channel blocker, iv

‐9.8

‐31.9

Nitric oxide donor

‐9.3

‐7

‐1

Diuretic, thiazide‐like

‐20.0

‐15

Low BP target

‐11.4

‐10

‐8

Overall

‐11.2

‐7.7

‐7

ACE‐I: angiotensin converting enzyme inhibitors
BP: blood pressure
SBP: systolic blood pressure
iv: intravenous

Figuras y tablas -
Table 2. Blood pressure changes by type of intervention
Table 3. Heart rate changes at day 1

Type of intervention

Trials

Participants

Day 1

95% CI

ACE (oral)

2

39

0.03

‐40.4 to 40.5

Alpha‐2 adrenoceptor agonist

1

3

Calcium channel blocker, oral

2

83

‐2.6

‐7.7 to 2.6

Calcium channel blocker, iv

1

11

‐16.9

‐27.4 to ‐6.5

Nitric oxide donor

5

4197

4.5

1.5 to 7.6

ACE: angiotensin converting enzyme
iv: intravenous

Figuras y tablas -
Table 3. Heart rate changes at day 1
Comparison 1. Blood pressure lowering therapy in acute stroke

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency, end of trial by intervention Show forest plot

16

15489

Odds Ratio (IV, Random, 95% CI)

0.98 [0.92, 1.05]

1.1 ACE inhibitors

2

126

Odds Ratio (IV, Random, 95% CI)

1.12 [0.53, 2.36]

1.2 ARA(po)

3

3737

Odds Ratio (IV, Random, 95% CI)

1.07 [0.93, 1.23]

1.3 Beta‐blockers

1

86

Odds Ratio (IV, Random, 95% CI)

1.03 [0.42, 2.55]

1.4 Nitric oxide donor

7

4194

Odds Ratio (IV, Random, 95% CI)

0.97 [0.86, 1.10]

1.5 Low BP target

4

7346

Odds Ratio (IV, Random, 95% CI)

0.95 [0.86, 1.04]

2 Death or dependency, end of trial by stroke type Show forest plot

16

15366

Odds Ratio (M‐H, Random, 95% CI)

0.98 [0.92, 1.05]

2.1 Ischaemic stroke

8

11015

Odds Ratio (M‐H, Random, 95% CI)

1.00 [0.92, 1.08]

2.2 Combined Ischaemic stroke and Intracerebral haemorrhage

5

142

Odds Ratio (M‐H, Random, 95% CI)

1.31 [0.64, 2.65]

2.3 Intracerebral haemorrhage

7

4209

Odds Ratio (M‐H, Random, 95% CI)

1.01 [0.84, 1.21]

3 Death or dependency, end of trial by stroke location Show forest plot

6

11950

Odds Ratio (M‐H, Random, 95% CI)

0.94 [0.87, 1.01]

3.1 Intracerebral haemorrhage, deep

3

2536

Odds Ratio (M‐H, Random, 95% CI)

0.86 [0.73, 1.00]

3.2 Intracerebral haemorrhage, superficial

3

851

Odds Ratio (M‐H, Random, 95% CI)

1.02 [0.77, 1.35]

3.3 Ischaemic stroke, cortical

4

6180

Odds Ratio (M‐H, Random, 95% CI)

0.94 [0.81, 1.09]

3.4 Ischaemic stroke, subcortical

4

2383

Odds Ratio (M‐H, Random, 95% CI)

0.98 [0.76, 1.27]

4 Death or dependency, end of trial by time to treatment Show forest plot

16

15489

Odds Ratio (M‐H, Random, 95% CI)

0.98 [0.92, 1.05]

4.1 Ultra‐acute/pre‐hospital

1

41

Odds Ratio (M‐H, Random, 95% CI)

0.36 [0.09, 1.43]

4.2 Hyper‐acute

3

3506

Odds Ratio (M‐H, Random, 95% CI)

0.87 [0.76, 0.99]

4.3 Acute

7

10440

Odds Ratio (M‐H, Random, 95% CI)

1.02 [0.94, 1.11]

4.4 Subacute

6

1502

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.84, 1.31]

5 Death, early by intervention Show forest plot

16

10050

Odds Ratio (IV, Random, 95% CI)

0.97 [0.74, 1.28]

5.1 ACE inhibitors (po)

4

164

Odds Ratio (IV, Random, 95% CI)

0.51 [0.06, 4.34]

5.2 ARA (po)

2

1379

Odds Ratio (IV, Random, 95% CI)

0.45 [0.05, 3.97]

5.3 Beta‐blockers

1

86

Odds Ratio (IV, Random, 95% CI)

0.25 [0.02, 2.93]

5.4 Calcium channel blockers (po)

1

77

Odds Ratio (IV, Random, 95% CI)

0.65 [0.17, 2.50]

5.5 Calcium channel blockers (iv)

1

11

Odds Ratio (IV, Random, 95% CI)

2.69 [0.10, 73.20]

5.6 Nitric oxide donor

7

4189

Odds Ratio (IV, Random, 95% CI)

0.79 [0.37, 1.72]

5.7 Low BP target

2

4144

Odds Ratio (IV, Random, 95% CI)

1.10 [0.66, 1.83]

6 Death, early by stroke type Show forest plot

13

9925

Odds Ratio (M‐H, Random, 95% CI)

1.02 [0.76, 1.35]

6.1 Ischaemic stroke

6

8844

Odds Ratio (M‐H, Random, 95% CI)

1.00 [0.73, 1.38]

6.2 Combined ischaemic stroke and intracerebral haemorrhage

6

373

Odds Ratio (M‐H, Random, 95% CI)

0.72 [0.25, 2.05]

6.3 Intracerebral haemorrhage

3

708

Odds Ratio (M‐H, Random, 95% CI)

1.27 [0.61, 2.61]

7 Death, early by time to treatment Show forest plot

15

10028

Odds Ratio (M‐H, Random, 95% CI)

1.03 [0.79, 1.36]

7.1 Ultra‐acute/prehospital

2

47

Odds Ratio (M‐H, Random, 95% CI)

1.16 [0.09, 14.29]

7.2 Hyper‐acute

1

270

Odds Ratio (M‐H, Random, 95% CI)

1.55 [0.59, 4.05]

7.3 Acute

6

8182

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.78, 1.41]

7.4 Subacute

7

1529

Odds Ratio (M‐H, Random, 95% CI)

0.40 [0.11, 1.42]

8 Death, end of trial by intervention Show forest plot

20

15818

Odds Ratio (IV, Random, 95% CI)

0.95 [0.84, 1.06]

8.1 ACE inhibitors (po)

4

165

Odds Ratio (IV, Random, 95% CI)

0.47 [0.15, 1.48]

8.2 ARA (po)

5

4120

Odds Ratio (IV, Random, 95% CI)

0.92 [0.59, 1.44]

8.3 Beta‐blockers

1

86

Odds Ratio (IV, Random, 95% CI)

0.57 [0.17, 1.89]

8.4 Nitric oxide donor

7

4197

Odds Ratio (IV, Random, 95% CI)

0.86 [0.72, 1.04]

8.5 Low BP target

4

7250

Odds Ratio (IV, Random, 95% CI)

1.04 [0.87, 1.25]

9 Death, end of trial by stroke type Show forest plot

20

15750

Odds Ratio (M‐H, Random, 95% CI)

0.95 [0.84, 1.07]

9.1 Ischaemic stroke

10

11238

Odds Ratio (M‐H, Random, 95% CI)

0.95 [0.78, 1.16]

9.2 Combined ischaemic stroke and intracerebral haemorrhage

7

328

Odds Ratio (M‐H, Random, 95% CI)

0.59 [0.29, 1.22]

9.3 Intracerebral haemorrhage

6

4184

Odds Ratio (M‐H, Random, 95% CI)

0.98 [0.82, 1.18]

10 Death, end of trial by time to treatment Show forest plot

20

15818

Odds Ratio (M‐H, Random, 95% CI)

0.90 [0.75, 1.08]

10.1 Ultra‐acute/pre‐hospital

2

52

Odds Ratio (M‐H, Random, 95% CI)

0.47 [0.11, 2.07]

10.2 Hyper‐acute

3

3506

Odds Ratio (M‐H, Random, 95% CI)

0.70 [0.38, 1.26]

10.3 Acute

8

10708

Odds Ratio (M‐H, Random, 95% CI)

0.97 [0.77, 1.22]

10.4 Subacute

8

1552

Odds Ratio (M‐H, Random, 95% CI)

0.92 [0.39, 2.15]

11 Barthel Index, end of trial, by intervention Show forest plot

2

4350

Mean Difference (IV, Random, 95% CI)

0.63 [‐3.28, 4.54]

11.1 ARA

1

339

Mean Difference (IV, Random, 95% CI)

‐1.90 [‐6.46, 2.66]

11.2 Nitric oxide donor

1

4011

Mean Difference (IV, Random, 95% CI)

2.20 [‐0.20, 4.60]

12 Barthel Index, end of trial, by stroke type Show forest plot

2

4310

Mean Difference (IV, Random, 95% CI)

1.33 [‐1.04, 3.69]

12.1 Ischaemic stroke

2

3681

Mean Difference (IV, Random, 95% CI)

0.84 [‐3.21, 4.89]

12.2 Intracerebral haemorrhage

1

629

Mean Difference (IV, Random, 95% CI)

0.90 [‐5.18, 6.98]

13 Barthel Index, end of trial, by time to treatment Show forest plot

2

4350

Mean Difference (IV, Random, 95% CI)

‐5.43 [‐14.19, 3.33]

13.1 Ultra‐acute

1

273

Mean Difference (IV, Random, 95% CI)

‐18.0 [‐25.66, ‐10.34]

13.2 Acute

2

4077

Mean Difference (IV, Random, 95% CI)

0.30 [‐2.64, 3.24]

14 Early neurological deterioration, by intervention Show forest plot

7

7575

Odds Ratio (M‐H, Random, 95% CI)

1.07 [0.92, 1.24]

14.1 ACE inhibitors

1

86

Odds Ratio (M‐H, Random, 95% CI)

1.59 [0.30, 8.41]

14.2 Beta‐blockers

1

86

Odds Ratio (M‐H, Random, 95% CI)

0.53 [0.03, 8.74]

14.3 Nitric oxide donor

2

4052

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.66, 1.98]

14.4 Low BP target

4

3351

Odds Ratio (M‐H, Random, 95% CI)

0.97 [0.80, 1.18]

15 Early neurological deterioration, by stroke type Show forest plot

7

7507

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.91, 1.24]

15.1 Ischaemic stroke

2

3349

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.09, 3.82]

15.2 Combined ischaemic stroke and intracerebral haemorrhage

1

172

Odds Ratio (M‐H, Random, 95% CI)

1.23 [0.31, 4.95]

15.3 Intracerebral haemorrhage

6

3986

Odds Ratio (M‐H, Random, 95% CI)

1.01 [0.84, 1.22]

16 Early neurological deterioration, by time to treatment Show forest plot

7

7575

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.87, 1.30]

16.1 Ultra‐acute

1

41

Odds Ratio (M‐H, Random, 95% CI)

0.55 [0.13, 2.32]

16.2 Hyper‐acute

3

3506

Odds Ratio (M‐H, Random, 95% CI)

0.94 [0.77, 1.13]

16.3 Acute

4

4028

Odds Ratio (M‐H, Random, 95% CI)

1.39 [1.07, 1.81]

17 Quality of life (EuroQol) at end of trial, by intervention Show forest plot

3

6881

Mean Difference (IV, Fixed, 95% CI)

0.02 [0.01, 0.04]

17.1 Nitric oxide donor

2

4052

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.01, 0.03]

17.2 Low BP target

1

2829

Mean Difference (IV, Fixed, 95% CI)

0.05 [0.02, 0.08]

18 Quality of life (EuroQoL) at end of trial, by stroke type Show forest plot

3

7502

Mean Difference (IV, Random, 95% CI)

0.03 [‐0.01, 0.07]

18.1 Ischaemic stroke

2

4038

Mean Difference (IV, Random, 95% CI)

0.13 [‐0.14, 0.40]

18.2 Intracerebral haemorrhage

3

3464

Mean Difference (IV, Random, 95% CI)

0.02 [‐0.03, 0.08]

19 Quality of life (EuroQoL) at end of trial, by time to treatment Show forest plot

3

6867

Mean Difference (IV, Random, 95% CI)

0.05 [‐0.00, 0.11]

19.1 Ultra‐acute

1

27

Mean Difference (IV, Random, 95% CI)

0.29 [0.07, 0.51]

19.2 Hyperacute

2

3102

Mean Difference (IV, Random, 95% CI)

0.06 [0.03, 0.08]

19.3 Acute

1

3738

Mean Difference (IV, Random, 95% CI)

0.0 [‐0.02, 0.02]

20 Length of stay, by intervention Show forest plot

4

8295

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.30, 0.28]

20.1 ACE inhibitors

1

86

Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐2.11, 1.85]

20.2 Beta‐blockers

1

86

Mean Difference (IV, Fixed, 95% CI)

0.21 [‐1.76, 2.18]

20.3 Nitric oxide donor

2

4052

Mean Difference (IV, Fixed, 95% CI)

‐0.31 [‐1.76, 1.14]

20.4 Low BP target

1

4071

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.31, 0.31]

21 Length of stay, by stroke type Show forest plot

3

8194

Mean Difference (IV, Random, 95% CI)

‐0.00 [‐0.30, 0.29]

21.1 Ischaemic stroke

2

7393

Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.33, 0.28]

21.2 Combined ischaemic and Intracerebral haemorrhage

1

172

Mean Difference (IV, Random, 95% CI)

0.20 [‐1.20, 1.60]

21.3 Intracerebral haemorrhage

1

629

Mean Difference (IV, Random, 95% CI)

2.60 [‐1.49, 6.69]

22 Length of stay, by time to treatment Show forest plot

4

8295

Mean Difference (IV, Random, 95% CI)

‐0.01 [‐0.30, 0.29]

22.1 Ultra‐acute

2

314

Mean Difference (IV, Random, 95% CI)

‐1.88 [‐6.58, 2.83]

22.2 Acute

3

7981

Mean Difference (IV, Random, 95% CI)

0.00 [‐0.29, 0.30]

23 SBP, first after randomisation, by intervention Show forest plot

24

15432

Mean Difference (IV, Random, 95% CI)

‐9.83 [‐12.11, ‐7.56]

23.1 ACE inhibitors(po)

5

123

Mean Difference (IV, Random, 95% CI)

‐13.68 [‐20.03, ‐7.32]

23.2 ACE inhibitors (s/l)

1

42

Mean Difference (IV, Random, 95% CI)

‐4.00 [‐17.55, 5.55]

23.3 ARA (po)

3

3408

Mean Difference (IV, Random, 95% CI)

‐4.59 [‐7.71, ‐1.48]

23.4 A2AA(po)

1

4

Mean Difference (IV, Random, 95% CI)

‐13.67 [‐41.48, 14.14]

23.5 Beta‐blockers (po)

1

44

Mean Difference (IV, Random, 95% CI)

‐11.5 [‐20.29, ‐2.71]

23.6 Beta‐blockers (iv)

1

41

Mean Difference (IV, Random, 95% CI)

‐16.40 [‐27.40, ‐5.40]

23.7 Calcium channel blockers (po)

3

106

Mean Difference (IV, Random, 95% CI)

‐7.62 [‐17.21, 1.96]

23.8 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

‐9.76 [‐24.42, 4.90]

23.9 Nitric oxide donor

7

4192

Mean Difference (IV, Random, 95% CI)

‐9.25 [‐14.54, ‐3.96]

23.10 Thiazide‐like diuretic (po)

1

40

Mean Difference (IV, Random, 95% CI)

‐20.0 [‐38.60, ‐1.40]

23.11 Low BP target

5

7421

Mean Difference (IV, Random, 95% CI)

‐11.39 [‐15.30, ‐7.49]

24 SBP, first after randomisation by stroke type Show forest plot

22

15659

Mean Difference (IV, Random, 95% CI)

‐8.77 [‐11.04, ‐6.50]

24.1 Ischaemic stroke

10

9256

Mean Difference (IV, Random, 95% CI)

‐6.99 [‐8.61, ‐5.38]

24.2 Combined ischaemic stroke and intracerebral haemorrhage

9

2466

Mean Difference (IV, Random, 95% CI)

‐7.89 [‐12.43, ‐3.36]

24.3 Intracerebral haemorrhage

4

3937

Mean Difference (IV, Random, 95% CI)

‐11.77 [‐15.25, ‐8.30]

25 SBP, first after randomisation by time to treatment Show forest plot

17

15211

Mean Difference (IV, Random, 95% CI)

‐9.67 [‐12.14, ‐7.20]

25.1 Ultra‐acute/prehospital

2

55

Mean Difference (IV, Random, 95% CI)

‐15.98 [‐30.43, ‐1.53]

25.2 Hyper‐acute

3

3506

Mean Difference (IV, Random, 95% CI)

‐13.38 [‐15.41, ‐11.35]

25.3 Acute

6

10120

Mean Difference (IV, Random, 95% CI)

‐7.23 [‐9.83, ‐4.63]

25.4 Subacute

7

1530

Mean Difference (IV, Random, 95% CI)

‐7.26 [‐10.02, ‐4.50]

26 SBP, at day 1 Show forest plot

18

14203

Mean Difference (IV, Random, 95% CI)

‐8.33 [‐10.97, ‐5.69]

26.1 ACE inhibitors (po)

5

120

Mean Difference (IV, Random, 95% CI)

‐7.90 [‐16.83, 1.03]

26.2 ACE inhibitors (s/l)

1

42

Mean Difference (IV, Random, 95% CI)

‐12.0 [‐25.60, 1.60]

26.3 ARA (po)

2

2368

Mean Difference (IV, Random, 95% CI)

‐0.50 [‐2.52, 1.51]

26.4 A2AA (po)

1

4

Mean Difference (IV, Random, 95% CI)

‐21.83 [‐66.12, 22.46]

26.5 Beta‐blockers(po)

1

44

Mean Difference (IV, Random, 95% CI)

‐14.00 [‐27.28, ‐0.72]

26.6 Beta‐blockers (iv)

1

43

Mean Difference (IV, Random, 95% CI)

‐5.0 [‐18.44, 8.44]

26.7 Calcium channel blockers (po)

2

84

Mean Difference (IV, Random, 95% CI)

‐13.23 [‐43.36, 16.91]

26.8 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

‐31.90 [‐64.73, 0.93]

26.9 Nitric oxide donor

7

4183

Mean Difference (IV, Random, 95% CI)

‐12.10 [‐19.06, ‐5.14]

26.10 Low BP target

3

7304

Mean Difference (IV, Random, 95% CI)

‐10.04 [‐12.47, ‐7.61]

27 SBP, at day 7 Show forest plot

11

15151

Mean Difference (IV, Random, 95% CI)

‐6.74 [‐9.39, ‐4.10]

27.1 ACE inhibitors

1

11

Mean Difference (IV, Random, 95% CI)

‐26.0 [‐43.00, ‐7.00]

27.2 ARA(po)

4

3747

Mean Difference (IV, Random, 95% CI)

‐5.74 [‐7.44, ‐4.03]

27.3 Thiazide‐like diuretic (po)

1

37

Mean Difference (IV, Random, 95% CI)

‐15.0 [‐34.25, 4.25]

27.4 Nitric oxide donor

2

4052

Mean Difference (IV, Random, 95% CI)

‐1.16 [‐2.63, 0.31]

27.5 Low BP target

3

7304

Mean Difference (IV, Random, 95% CI)

‐7.62 [‐11.69, ‐3.56]

28 SBP, at end of treatment Show forest plot

20

15684

Mean Difference (IV, Random, 95% CI)

‐8.02 [‐10.07, ‐5.97]

28.1 ACE inhibitors (po)

4

123

Mean Difference (IV, Random, 95% CI)

‐17.37 [‐23.42, ‐11.31]

28.2 ACE inhibitors (s/l)

1

42

Mean Difference (IV, Random, 95% CI)

‐1.5 [‐12.20, 9.20]

28.3 ARA (po)

5

3785

Mean Difference (IV, Random, 95% CI)

‐7.37 [‐10.19, ‐4.56]

28.4 A2AA (po)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

28.5 Beta‐blockers (po)

1

44

Mean Difference (IV, Random, 95% CI)

‐3.20 [‐13.17, 6.77]

28.6 Beta‐blockers (iv)

1

43

Mean Difference (IV, Random, 95% CI)

‐13.00 [‐25.21, ‐4.79]

28.7 Calcium channel blockers (po)

1

77

Mean Difference (IV, Random, 95% CI)

‐7.80 [‐17.12, 1.52]

28.8 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

‐9.20 [‐25.73, 7.33]

28.9 Nitric oxide donor

4

4101

Mean Difference (IV, Random, 95% CI)

‐1.05 [‐2.50, 0.39]

28.10 Thiazide‐like diuretic (po)

1

37

Mean Difference (IV, Random, 95% CI)

3.0 [‐11.74, 17.74]

28.11 Low BP target

5

7421

Mean Difference (IV, Random, 95% CI)

‐10.06 [‐13.58, ‐6.55]

29 DBP, first after randomisation by intervention Show forest plot

17

12397

Mean Difference (IV, Random, 95% CI)

‐3.86 [‐5.07, ‐2.64]

29.1 ACE inhibitors(po)

5

123

Mean Difference (IV, Random, 95% CI)

‐4.23 [‐9.68, 1.21]

29.2 ACE inhibitors (s/l)

1

42

Mean Difference (IV, Random, 95% CI)

2.20 [‐5.50, 9.90]

29.3 ARA (po)

3

3408

Mean Difference (IV, Random, 95% CI)

‐2.48 [‐4.35, ‐0.61]

29.4 A2AA

1

4

Mean Difference (IV, Random, 95% CI)

‐2.10 [‐15.43, 11.23]

29.5 Beta‐Blockers (po)

1

43

Mean Difference (IV, Random, 95% CI)

‐5.40 [‐13.01, 2.21]

29.6 Beta‐Blockers (iv)

1

41

Mean Difference (IV, Random, 95% CI)

‐17.5 [‐25.32, ‐9.68]

29.7 Calcium channel blockers (po)

1

77

Mean Difference (IV, Random, 95% CI)

‐3.30 [‐9.28, 2.68]

29.8 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

‐12.90 [‐31.35, 5.55]

29.9 Nitric oxide donor

6

4173

Mean Difference (IV, Random, 95% CI)

‐3.39 [‐4.25, ‐2.52]

29.10 Low BP target

2

4475

Mean Difference (IV, Random, 95% CI)

‐6.43 [‐12.10, ‐0.75]

30 DBP, first after randomisation by stroke type Show forest plot

16

14952

Mean Difference (IV, Random, 95% CI)

‐3.73 [‐4.69, ‐2.76]

30.1 Ischaemic stroke

6

7500

Mean Difference (IV, Random, 95% CI)

‐3.53 [‐4.20, ‐2.87]

30.2 Combined ischaemic stroke and Intracerebral haemorrhage

10

6419

Mean Difference (IV, Random, 95% CI)

‐2.85 [‐4.26, ‐1.44]

30.3 Intracerebral haemorrhage

2

1033

Mean Difference (IV, Random, 95% CI)

‐6.80 [‐11.99, ‐1.60]

31 DBP, first after randomisation by time to treatment Show forest plot

16

10977

Mean Difference (IV, Random, 95% CI)

‐3.80 [‐5.06, ‐2.54]

31.1 Ultra‐acute/prehospital

2

55

Mean Difference (IV, Random, 95% CI)

1.39 [‐7.71, 10.48]

31.2 Hyper‐acute

2

677

Mean Difference (IV, Random, 95% CI)

‐6.48 [‐12.55, ‐0.41]

31.3 Acute

6

10076

Mean Difference (IV, Random, 95% CI)

‐3.11 [‐4.26, ‐1.97]

31.4 Subacute

7

169

Mean Difference (IV, Random, 95% CI)

‐3.88 [‐7.98, 0.22]

32 DBP, at day 1 Show forest plot

16

11361

Mean Difference (IV, Random, 95% CI)

‐3.05 [‐4.20, ‐1.91]

32.1 ACE inhibitors (po)

4

96

Mean Difference (IV, Random, 95% CI)

‐3.24 [‐8.95, 2.47]

32.2 ACE inhibitors (s/l)

1

42

Mean Difference (IV, Random, 95% CI)

‐2.0 [‐9.70, 5.70]

32.3 ARA (po)

2

2368

Mean Difference (IV, Random, 95% CI)

1.00 [‐3.47, 1.48]

32.4 A2AA (po)

1

4

Mean Difference (IV, Random, 95% CI)

0.17 [‐26.77, 27.11]

32.5 Beta‐blockers (po)

1

43

Mean Difference (IV, Random, 95% CI)

‐1.0 [‐8.99, 6.99]

32.6 Beta‐blockers (iv)

1

41

Mean Difference (IV, Random, 95% CI)

‐5.0 [‐13.21, 3.21]

32.7 Calcium channel blockers (po)

2

84

Mean Difference (IV, Random, 95% CI)

‐6.10 [‐14.08, 1.89]

32.8 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

‐12.90 [‐31.35, 5.55]

32.9 Nitric oxide donor

7

4197

Mean Difference (IV, Random, 95% CI)

‐3.31 [‐4.17, ‐2.44]

32.10 Low BP target

2

4475

Mean Difference (IV, Random, 95% CI)

‐5.34 [‐9.02, ‐1.65]

33 DBP, at day 7 Show forest plot

10

12686

Mean Difference (IV, Random, 95% CI)

‐2.90 [‐3.96, ‐1.83]

33.1 ACE inhibitors

1

11

Mean Difference (IV, Random, 95% CI)

‐18.0 [‐33.10, ‐2.90]

33.2 ARA(po)

5

4152

Mean Difference (IV, Random, 95% CI)

‐2.47 [‐3.24, ‐1.70]

33.3 Nitric oxide donor

1

4011

Mean Difference (IV, Random, 95% CI)

‐1.10 [‐2.00, ‐0.20]

33.4 Thiazide‐like diuretic (po)

1

37

Mean Difference (IV, Random, 95% CI)

‐5.0 [‐16.00, 6.00]

33.5 Low BP target

2

4475

Mean Difference (IV, Random, 95% CI)

‐4.49 [‐6.18, ‐2.80]

34 DBP, at end of treatment Show forest plot

15

13050

Mean Difference (IV, Random, 95% CI)

‐3.95 [‐5.15, ‐2.75]

34.1 ACE inhibitors (po)

4

123

Mean Difference (IV, Random, 95% CI)

‐6.06 [‐11.18, ‐0.95]

34.2 ARA (po)

6

4190

Mean Difference (IV, Random, 95% CI)

‐3.61 [‐5.61, ‐1.61]

34.3 ACE inhibitors (s/l)

1

42

Mean Difference (IV, Random, 95% CI)

0.0 [‐7.70, 7.70]

34.4 Beta‐blockers (po)

1

43

Mean Difference (IV, Random, 95% CI)

0.90 [‐7.48, 9.28]

34.5 Beta‐Blockers (iv)

1

41

Mean Difference (IV, Random, 95% CI)

‐16.40 [‐24.22, ‐8.58]

34.6 Calcium channel blockers (po)

1

77

Mean Difference (IV, Random, 95% CI)

‐9.40 [‐15.50, ‐3.30]

34.7 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

‐2.90 [‐21.35, 15.55]

34.8 Nitric oxide donor

1

4011

Mean Difference (IV, Random, 95% CI)

‐1.10 [‐2.00, ‐0.20]

34.9 Thiazide‐like diuretic (po)

1

37

Mean Difference (IV, Random, 95% CI)

‐4.0 [‐13.03, 5.03]

34.10 Low BP target

2

4475

Mean Difference (IV, Random, 95% CI)

‐4.24 [‐5.62, ‐2.86]

35 HR at baseline Show forest plot

15

5841

Mean Difference (IV, Random, 95% CI)

0.07 [‐0.86, 0.99]

35.1 ACE inhibitors (po)

3

61

Mean Difference (IV, Random, 95% CI)

0.22 [‐5.31, 5.75]

35.2 ARA(po)

2

1379

Mean Difference (IV, Random, 95% CI)

‐0.34 [‐1.57, 0.90]

35.3 A2AA (po)

1

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

35.4 Calcium channel blockers (po)

2

79

Mean Difference (IV, Random, 95% CI)

‐3.60 [‐9.47, 2.27]

35.5 Nitric oxide donor

7

4197

Mean Difference (IV, Random, 95% CI)

2.26 [‐1.26, 5.77]

35.6 Thiazide‐like diuretic (po)

1

37

Mean Difference (IV, Random, 95% CI)

‐4.0 [‐10.50, 2.50]

35.7 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

5.30 [‐4.21, 14.81]

35.8 Low BP target

1

75

Mean Difference (IV, Random, 95% CI)

‐3.0 [‐10.53, 4.53]

36 HR, first after randomisation Show forest plot

6

4196

Mean Difference (IV, Random, 95% CI)

2.74 [‐1.13, 6.61]

36.1 ACE inhibitors (po)

2

39

Mean Difference (IV, Random, 95% CI)

‐0.58 [‐9.89, 8.72]

36.2 ARA(po)

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.3 Calcium channel blockers (po)

2

82

Mean Difference (IV, Random, 95% CI)

1.28 [‐21.89, 24.46]

36.4 A2AA (po)

1

3

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

36.5 Nitric oxide donor

3

4061

Mean Difference (IV, Random, 95% CI)

3.95 [‐1.03, 8.93]

36.6 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

10.0 [0.71, 19.29]

37 HR, at day 1 Show forest plot

10

4333

Mean Difference (IV, Random, 95% CI)

2.35 [‐1.06, 5.76]

37.1 ACE inhibitors (po)

2

39

Mean Difference (IV, Random, 95% CI)

0.03 [‐40.45, 40.51]

37.2 Calcium channel blockers (po)

2

83

Mean Difference (IV, Random, 95% CI)

‐2.56 [‐7.71, 2.59]

37.3 A2AA (po)

1

3

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

37.4 Nitric oxide donor

7

4197

Mean Difference (IV, Random, 95% CI)

4.53 [1.46, 7.60]

37.5 Calcium channel blockers (iv)

1

11

Mean Difference (IV, Random, 95% CI)

‐16.90 [‐27.35, ‐6.45]

38 HR, at day 7 Show forest plot

4

5449

Mean Difference (IV, Random, 95% CI)

0.47 [‐0.24, 1.19]

38.1 Thiazide‐like diuretic (po)

1

37

Mean Difference (IV, Random, 95% CI)

0.0 [‐6.14, 6.14]

38.2 ARA(po)

1

1360

Mean Difference (IV, Random, 95% CI)

0.10 [‐1.07, 1.27]

38.3 Nitric oxide donor

2

4052

Mean Difference (IV, Random, 95% CI)

0.72 [‐0.20, 1.63]

39 HR, at end of treatment Show forest plot

4

4124

Mean Difference (IV, Random, 95% CI)

0.70 [‐0.21, 1.61]

39.1 ACE inhibitors

1

35

Mean Difference (IV, Random, 95% CI)

2.40 [‐62.22, 67.02]

39.2 Thiazide‐ like diuretic

1

37

Mean Difference (IV, Random, 95% CI)

0.0 [‐6.14, 6.14]

39.3 Nitric oxide donor

2

4052

Mean Difference (IV, Random, 95% CI)

0.72 [‐0.20, 1.63]

Figuras y tablas -
Comparison 1. Blood pressure lowering therapy in acute stroke
Comparison 2. Blood pressure altering by continue or stop prestroke antihypertensives (C/S)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependency, end of trial by C/S Show forest plot

2

2860

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.91, 1.24]

2 Death or dependency, end of trial by stroke type C/S Show forest plot

2

2841

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.91, 1.24]

2.1 Ischaemic stroke

1

1832

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.87, 1.28]

2.2 Combined ischaemic stroke and intracerebral haemorrhage

1

763

Odds Ratio (M‐H, Random, 95% CI)

1.10 [0.82, 1.48]

2.3 Intracerebral haemorrhage

1

246

Odds Ratio (M‐H, Random, 95% CI)

0.95 [0.55, 1.65]

3 Death or dependency, end of trial by time to treatment Show forest plot

2

2860

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.91, 1.24]

3.1 Ultra‐acute

1

143

Odds Ratio (M‐H, Random, 95% CI)

1.34 [0.69, 2.61]

3.2 Acute

2

2717

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.89, 1.23]

4 Death early, by C/S Show forest plot

2

2860

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.55, 2.00]

5 Death early, by stroke type C/S Show forest plot

2

2841

Odds Ratio (M‐H, Random, 95% CI)

1.03 [0.56, 1.87]

5.1 Ischaemic stroke

1

1832

Odds Ratio (M‐H, Random, 95% CI)

1.37 [0.79, 2.36]

5.2 Combined ischaemic stroke and intracerebral haemorrhage

1

763

Odds Ratio (M‐H, Random, 95% CI)

0.57 [0.17, 1.98]

5.3 Intracerebral haemorrhage

1

246

Odds Ratio (M‐H, Random, 95% CI)

0.53 [0.09, 2.92]

6 Death early, by time to treatment C/S Show forest plot

2

2860

Odds Ratio (M‐H, Random, 95% CI)

1.08 [0.60, 1.93]

6.1 Ultra‐acute

1

143

Odds Ratio (M‐H, Random, 95% CI)

5.68 [0.27, 120.37]

6.2 Acute

2

2717

Odds Ratio (M‐H, Random, 95% CI)

1.03 [0.61, 1.76]

7 Death, end of trial by C/S Show forest plot

2

2860

Odds Ratio (M‐H, Random, 95% CI)

1.15 [0.92, 1.43]

8 Death end of trial, by stroke type C/S Show forest plot

2

2839

Odds Ratio (M‐H, Random, 95% CI)

1.18 [0.94, 1.47]

8.1 Ischaemic stroke

1

1832

Odds Ratio (M‐H, Random, 95% CI)

1.24 [0.96, 1.61]

8.2 Combined ischaemic stroke and intracerebral haemorrhage

1

763

Odds Ratio (M‐H, Random, 95% CI)

1.13 [0.67, 1.91]

8.3 Intracerebral haemorrhage

1

244

Odds Ratio (M‐H, Random, 95% CI)

0.88 [0.45, 1.71]

9 Death, end of trial by time to treatment C/S Show forest plot

2

2860

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.92, 1.42]

9.1 Ultra‐acute

1

143

Odds Ratio (M‐H, Random, 95% CI)

1.87 [0.68, 5.15]

9.2 Acute

2

2717

Odds Ratio (M‐H, Random, 95% CI)

1.12 [0.89, 1.40]

10 Barthel Index, end of trial, by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐3.18 [‐5.80, ‐0.55]

11 Early neurological deterioration, by C/S Show forest plot

1

2097

Odds Ratio (M‐H, Random, 95% CI)

1.27 [0.89, 1.82]

12 Quality of life (EuroQol) at end of trial, by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.05, ‐0.01]

13 Length of stay, by C/S Show forest plot

1

2097

Mean Difference (IV, Random, 95% CI)

1.20 [‐0.87, 3.27]

14 SBP, first after randomisation, by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐3.11 [‐4.75, ‐1.46]

15 SBP, at day 1 by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐3.11 [‐4.75, ‐1.46]

16 SBP, at end of treatment by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐11.30 [‐15.20, ‐7.40]

17 DBP, at baseline by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐0.69 [‐1.65, 0.27]

18 DBP at day 1, by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐1.16 [‐2.24, ‐0.08]

19 DBP, at end of treatment by C/S Show forest plot

2

2860

Mean Difference (IV, Random, 95% CI)

‐6.45 [‐9.28, ‐3.61]

20 HR, at day 1 Show forest plot

1

2097

Mean Difference (IV, Fixed, 95% CI)

0.60 [‐0.70, 1.90]

21 HR, at end of treatment Show forest plot

1

2097

Mean Difference (IV, Fixed, 95% CI)

‐3.20 [‐4.51, ‐1.89]

Figuras y tablas -
Comparison 2. Blood pressure altering by continue or stop prestroke antihypertensives (C/S)
Comparison 3. Blood pressure elevation therapy in acute stroke

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death early, by intervention Show forest plot

1

15

Odds Ratio (IV, Random, 95% CI)

0.0 [0.0, 0.0]

1.1 Phenylephrine (iv)

1

15

Odds Ratio (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 Death early, by stroke type Show forest plot

1

15

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.1 Ischaemic stroke

1

15

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 Death end of trial, by intervention Show forest plot

1

15

Odds Ratio (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.1 Phenylephrine (iv)

1

15

Odds Ratio (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 SBP, at baseline Show forest plot

1

15

Mean Difference (IV, Random, 95% CI)

‐27.5 [‐50.83, ‐4.17]

4.1 Phenylephrine (iv)

1

15

Mean Difference (IV, Random, 95% CI)

‐27.5 [‐50.83, ‐4.17]

5 SBP, first after randomisation Show forest plot

1

15

Mean Difference (IV, Random, 95% CI)

20.60 [‐13.31, 54.51]

6 SBP, at day 1 Show forest plot

1

15

Mean Difference (IV, Random, 95% CI)

20.60 [‐13.31, 54.51]

7 DBP, at baseline Show forest plot

1

15

Mean Difference (IV, Random, 95% CI)

‐8.30 [‐19.13, 2.53]

8 DBP, first after randomisation Show forest plot

1

15

Mean Difference (IV, Random, 95% CI)

0.5 [‐14.86, 15.86]

9 DBP, at day 1 Show forest plot

1

15

Mean Difference (IV, Random, 95% CI)

0.5 [‐14.86, 15.86]

Figuras y tablas -
Comparison 3. Blood pressure elevation therapy in acute stroke