Relationship Between Blood Pressure And Prognosis In Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

Part IObjective:To evaluate the efficacy of intensive blood pressure lowering in patients with acute ischemic stroke treated with intravenous thrombolysis.Methods:Computer-based retrieval of literature databases,including CENTRAL,EMbase,Pubmed,CBM,CNKI,Wan Fang and VIP,was conducted to search for articles about the efficacy of intensive blood pressure lowering in patients with acute ischemic stroke treated with intravenous thrombolysis,and the retrieval time was from the establishment of database to September 2018.Systolic blood pressure in treatment group patients were controlled in 130 to 150 mmHg while matched group patients were controlled below 185 mmHg according guideline.Two reviewers independently selected the literature,extracted the data and assessed the methodological quality of the included RCTs,and then meta-analysis was performed using RevMan 5.3 software.Results:A total of 6 RCTs involving 1317 patients were included.The meta-analysis indicated that early intensive BP-lowering treatment did not raise the risk of disability(mRS score 3~5)(OR=1.24,95%CI 0.99 to 1.56,P=0.07)and mortality(OR=0.70,95%CI 0.39 to 1.24,P=0.22)in 3 months,but significantly reduced the risk of hemorrhagic transformation(OR=0.42,95%CI 0.27 to 0.66,P=0.0001).Moreover,did not increase infarct volume(MD=0.48,95%CI=-2.14~3.11,P=0.72),without affecting blood reperfusion(OR=1.02,95%CI=0.67~1.55,P=0.94)and recanalization(OR=1.00,95%CI=0.49~2.05,P=1.00).Conclusion:Early intensive BP-lowering treatment can markedly reduce the risk of hemorrhagic transformation and not raise poor outcome.Part IIObjective:To assess the relationship between short-time blood pressure variability and poor outcome in patients with acute ischemic stroke treated with intravenous thrombolysis.Methods:Databases including CENTRAL,EMbase,Pubmed,CBM,CNKI,Wan Fang and VIP Data were searched from inception to December 2018 to identify the randomized controlled trials(RCTs),cohort studies and case-control studies about relationship between short-time systolic blood pressure variability and prognosis in patients undergoing intravenous thrombolytic therapy were enrolled.Studies were included only if authors reported odds ratios(OR)and 95% confidence intervals(CIs)for the effect of a defined increment(per 10-mmHg increase)in either SD of SBP(SD SBP)or coefficient of variation of SBP(CV SBP)or successive variation(SV),on outcome.Two reviewers independently selected the literature and extracted the data.Metaanalysis was performed using STATA 14.0 software.Results:A total of 11 cohort studies involving 19247 patients were included.Nine studies were debated about the relationship of short-time systolic blood pressure variability and hemorrhage transformation.The effect of short-time systolic blood pressure variability and poor outcome were discussed in nine studies.Three studies were investigated about the nexus of short-time systolic blood pressure variability and death.The results of meta-analysis revealed that short-time systolic blood pressure variability was related to hemorrhage transformation and poor outcome in patients with acute ischemic stroke.With the increase of systolic blood pressure variability,the risk of poor outcome(OR=1.58,95%CI 1.30 to 1.92,P=0.000)and hemorrhagic transformation(OR= 1.70,95%CI 1.34 to 2.15,P=0.000)increased accordingly.Conclusion:Short-time systolic blood pressure variability is an independent predictor of hemorrhage transformation and poor outcome in patients with acute ischemic stroke.With the increase of systolic blood pressure variability,the risk of poor outcome and hemorrhagic transformation increased accordingly.