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Meta-Analysis
. 2020 Mar;75(3):730-739.
doi: 10.1161/HYPERTENSIONAHA.119.14230. Epub 2020 Jan 13.

Association of Blood Pressure With Outcomes in Acute Stroke Thrombectomy

Konark Malhotra  1 , Nitin Goyal  2 , Aristeidis H Katsanos  3 , Angeliki Filippatou  4 , Eva A Mistry  5 , Pooja Khatri  6 , Mohammad Anadani  7   8 , Alejandro M Spiotta  8 , Else Charlotte Sandset  9   10 , Amrou Sarraj  11 , Georgios Magoufis  12 , Christos Krogias  13 , Lars Tönges  13 , Apostolos Safouris  12 , Lucas Elijovich  14 , Mayank Goyal  15 , Adam Arthur  14 , Andrei V Alexandrov  2 , Georgios Tsivgoulis  2   4
Affiliations
Meta-Analysis

Association of Blood Pressure With Outcomes in Acute Stroke Thrombectomy

Konark Malhotra et al. Hypertension. 2020 Mar.

Abstract

Limited data exist evaluating the effect of blood pressure (BP) on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with mechanical thrombectomy (MT). We sought to evaluate the association of BP levels on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with MT. Studies were identified that reported the association of systolic BP (SBP) or diastolic BP levels before, during, or after MT on the outcomes of patients with acute ischemic stroke treated with MT. Unadjusted and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed. Our analysis included 25 studies comprising 6474 patients. Higher pre-MT mean SBP (P=0.008) and post-MT maximum SBP (P=0.009) levels were observed in patients who died within 3 months. Patients with 3-month functional independence were noted to have lower pre-MT (P<0.001) and post-MT maximum SBP levels (P<0.001). In adjusted analyses, increasing post-MT maximum SBP and diastolic BP levels were associated with 3-month mortality (ORadj, 1.19 [95% CI,1.00-1.43]; I2=78%, P value for Cochran Q test: 0.001) and symptomatic intracranial hemorrhage (ORadj, 1.65 [95% CI, 1.11-2.44]; I2=0%, P value for Cochran Q test: 0.80), respectively. Increasing pre- and post-MT mean SBP levels were associated with lower odds of 3-month functional independence (ORadj, 0.86 [95% CI, 0.77-0.96]; I2=18%, P value for Cochran Q test: 0.30) and (ORadj, 0.80 [95% CI, 0.72-0.89]; I2=0%, P value for Cochran Q test: 0.51), respectively. In conclusion, elevated BP levels before and after MT are associated with adverse outcomes among patients with acute ischemic stroke with large vessel occlusion.

Keywords: blood pressure; consensus; intracranial hemorrhages; odds ratio; thrombectomy.

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Figures

Figure 1.
Figure 1.
Forest plot presenting the (A) unadjusted and (B) adjusted for potential confounders associations of post-mechanical thrombectomy (MT) mean systolic blood pressure levels with 3-mo functional independence. mRS indicates modified Rankin Scale.
Figure 2.
Figure 2.
Forest plot presenting the (A) unadjusted and (B) adjusted for potential confounders associations of post-mechanical thrombectomy (MT) maximum systolic blood pressure levels with 3-mo mortality. mRS indicates modified Rankin Scale.
Figure 3.
Figure 3.
Forest plot presenting the (A) unadjusted and (B) adjusted for potential confounders associations of post-mechanical thrombectomy (MT) maximum diastolic blood pressure levels with symptomatic intracranial hemorrhage. mRS indicates modified Rankin Scale,
See this image and copyright information in PMC

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