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<p>In this systematic review of randomized controlled trials, we examined the optimal blood pressure (BP) target for patients with prior stroke, comparing intensive BP control (systolic BP [SBP] &lt;130 mmHg) with standard BP control (SBP &lt; 140 mmHg). Literature searches of PubMed/MEDLINE, the Cochrane Database, and Ichu-shi identified seven randomized controlled trials for quantitative analysis. Meta-analyses were performed using random-effects models, with most included trials assessed as having low risks of bias. The meta-analysis showed significant reductions in recurrent stroke (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65–0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76–0.97) in the intensive BP control arm. Intensive BP control was more effective in reducing recurrent hemorrhagic stroke (RR, 0.33; 95% CI, 0.15–0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71–1.08). However, adverse events such as syncope or dizziness were significantly more frequent in the intensive BP control arm (RR, 1.30; 95% CI, 1.00–1.68). Absolute risk reductions (per 1,000 persons) for recurrent stroke (−14; 95% CI, −24 to −4) and major cardiovascular events (−17; 95% CI, −28 to −6) outweighed the absolute increase in syncope or dizziness (4; 95% CI, 0–9). We recommend a lower SBP target of &lt;130 mmHg, with careful monitoring for hypotension-related symptoms, to prevent recurrent stroke and major cardiovascular events in patients with prior stroke.</p><p></p>

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Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年3月17日

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  • Toshiki Maeda,
  • Yuichiro Ohya,
  • Shintaro Ishida,
  • Yori Inoue,
  • Takako Fujii,
  • Yuki Sakamoto,
  • Norihito Okina,
  • Tetsutaro Niijima,
  • Hisatomi Arima,
  • Kazunori Toyoda,
  • Hisashi Kai,
  • Masatoshi Koga

摘要

In this systematic review of randomized controlled trials, we examined the optimal blood pressure (BP) target for patients with prior stroke, comparing intensive BP control (systolic BP [SBP] <130 mmHg) with standard BP control (SBP < 140 mmHg). Literature searches of PubMed/MEDLINE, the Cochrane Database, and Ichu-shi identified seven randomized controlled trials for quantitative analysis. Meta-analyses were performed using random-effects models, with most included trials assessed as having low risks of bias. The meta-analysis showed significant reductions in recurrent stroke (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65–0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76–0.97) in the intensive BP control arm. Intensive BP control was more effective in reducing recurrent hemorrhagic stroke (RR, 0.33; 95% CI, 0.15–0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71–1.08). However, adverse events such as syncope or dizziness were significantly more frequent in the intensive BP control arm (RR, 1.30; 95% CI, 1.00–1.68). Absolute risk reductions (per 1,000 persons) for recurrent stroke (−14; 95% CI, −24 to −4) and major cardiovascular events (−17; 95% CI, −28 to −6) outweighed the absolute increase in syncope or dizziness (4; 95% CI, 0–9). We recommend a lower SBP target of <130 mmHg, with careful monitoring for hypotension-related symptoms, to prevent recurrent stroke and major cardiovascular events in patients with prior stroke.