This Article Full Text Full Text (PDF) All Versions of this Article: 40/5/e390    most recent STROKEAHA.108.535849v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Geeganage, C. M. Articles by Bath, P. M.W. Search for Related Content PubMed PubMed Citation Articles by Geeganage, C. M. Articles by Bath, P. M.W. Related Collections Cerebrovascular disease/stroke Clinical Studies Acute Cerebral Hemorrhage Acute Cerebral Infarction Emergency treatment of Stroke Other Stroke Treatment - Medical

(Stroke. 2009;40:e390.)
© 2009 American Heart Association, Inc.

Cochrane Corner

Interventions for Deliberately Altering Blood Pressure in Acute Stroke

From the Stroke Trials Unit, University of Nottingham, Nottingham, UK.

Correspondence to Philip M.W. Bath, MD, FRCP, Division of Stroke Medicine, University of Nottingham, Nottingham City Campus, Nottingham, NG5 1PB, UK. E-mail philip.bath@nottingham.ac.uk

Graeme J. Hankey MD, FRCP Section Editor

Key Words: acute stroke • blood pressure • randomized controlled trial

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
High blood pressure (BP) is common in both acute ischemic stroke and primary intracerebral hemorrhage. Both high and low BP are associated with a poor outcome. Hence, drugs that elevate a low BP or reduce a high BP might be beneficial. We systematically assessed the effect of deliberate BP-altering in patients with acute stroke.¹

	Search Strategy

 
We searched the Cochrane Stroke Group Trials Register, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, reference lists of relevant publications, and contacted researchers in the field. All randomized, controlled trials that aimed to alter BP in acute ischemic stroke or acute primary intracerebral hemorrhage were included; treatment had to be initiated within 1 week of stroke onset. Uncontrolled studies, controlled studies involving only active comparators, and studies of patients with subarachnoid hemorrhage were excluded.

Data on early and late case fatality, early neurological deterioration, late disability/dependency, stroke recurrence, quality of life, discharge site, hospital costs, baseline and on-treatment BP, and heart rate were sought, ideally by intention to treat. Methodological quality of the trials, especially relating to concealment of allocation, was also assessed. Data were analyzed using RevMan 5; OR with random-effects model for binary data and weighted mean difference for continuous data each with 95% CIs, were calculated.

	Main Results

 
Twelve trials involving 1153 participants (range, 15 to 404) were included (603 active, 550 placebo/control). The trials mostly tested drugs that lower BP: angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists (ARA), calcium channel blockers, clonidine, glyceryl trinitrate/nitroglycerine, thiazide . . . [Full Text of this Article]