Efficacy and safety of Intensive Blood Pressure Control in Ischemic Stroke Patients Following Endovascular Thrombectomy: A Update Meta-Analysis

Abstract

Objective This meta-analysis aimed to determine the potential benefits or effectiveness of intensive blood pressure management in ischemic stroke patients who have undergone endovascular thrombectomy (EVT) and make an effective update for the evidence. Methods We comprehensively searched all relevant studies published before May 23, 2024, using multiple databases, including Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI) and Wangfang. The primary outcome was 90 days functional independence (Modified Rankin Scale, mRS score = 0–2), while the secondary outcomes comprised 90-day mortality, 7-day mortality, symptomatic intracranial hemorrhage (sICH), complications and hemicraniectomy. Results 17 studies with a total of 5825 patients were included. The primary outcome: 90 days functional independence, a significant difference between different blood pressure management (OR = 1.58, 95% CI [1.17, 2.13]) was observed, with obvious heterogeneity (I² = 83.20%, p < 0.01). The secondary outcomes: The significant difference were found in 90-day mortality (OR = 0.75, 95% CI [0.58, 0.99]), sICH (OR = 0.74, 95% CI [0.58, 0.95]), hemicraniectomy (OR = 0.42, 95% CI [0.22, 0.81]). No significant difference were found in 7-day mortality (OR = 0.88, 95% CI [0.49, 1.58]), complications (OR = 1.32, 95% CI [0.50, 3.50]). Subgroup analysis for the heterogeneity. Conclusion Our results suggested that more intensive blood pressure management may yield greater benefits in terms of patients' clinic outcomes. However, the results should be interpreted cautiously. Additionally, blood pressure target of SBP < 140 mmHg may provide fundamental insights for future randomized controlled trials.