Intensive Versus Conservative Blood Pressure Lowering after Endovascular Therapy in Stroke: a meta-analysis of randomized controlled trials

Background The optimum systolic blood pressure after endovascular thrombectomy for acute ischemic stroke is uncertain. We aimed to perform an updated meta-analysis of randomized controlled trials to evaluate the safety and efficacy of more intensive blood pressure management as compared to less intensive blood pressure management. Methods We searched various electronic databases including Embase, MEDLINE (via PubMed), and CENTRAL to retrieve relevant randomized controlled trials (RCTs) on the clinical effects of more intensive blood pressure management after endovascular thrombectomy as compared to the less intensive management. We assessed the risk of bias using the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0), calculated risk ratio (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CI for continuous outcomes. Results Our meta-analysis included 4 RCTs with a total of 1560 patients. According to our analysis, more intensive blood pressure management was associated with a statistically significant decrease in the number of patients showing functional independence (modified Rankin scale mRS score=0-2) at 90 days (RR 0.81; CI = 0.72-0.91; I2 = 12%). Regarding 90-day mortality, our pooled results from three RCTs showed no statistically significant difference between the more intensive blood pressure management group and the less intensive blood pressure management group (RR 1.17; CI = 0.90-1.52; I2 = 0%). There was no statistically significant difference between the two groups regarding the incidence of intracerebral hemorrhage (ICH) (RR 1.05; CI = 0.90-1.23; I2 = 0%) and the incidence of symptomatic intracerebral hemorrhage (sICH) (RR 1.10; CI = 0.76-1.60; I2 = 0%). Conclusion According to our meta-analysis, no benefit of intensive lowering of blood pressure was observed in terms of functional independence at 90 days, mortality rates, and incidence of intracerebral hemorrhage. Future large-scale trials should focus on other interventions to improve prognosis in these patients. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used only openly available human data and all the data has been published in different journals and referenced in the manuscript. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.