Prehospital Blood Pressure Lowering in Patients with Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Whether prehospital blood pressure control improves outcomes among patients with acute ischemic stroke is uncertain. This systematic review and meta-analysis aimed to evaluate the effect of prehospital blood pressure reduction treatment in patients with ischemic stroke. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared prehospital blood pressure reduction treatment with usual treatment or no treatment in patients with stroke. The primary outcome was functional outcome, assessed with the distribution of modified Rankin Scale (mRS) at 90 days, while secondary outcome was mortality at 90 days. Results: Of 428 studies reviewed, three were appropriate for analysis, totaling 3878 patients. In patients with ischemic stroke, prehospital blood pressure reduction treatment was associated with higher mRS scores at 90 days (common OR for worse mRS OR 1.27, 95% CI 1.08–1.49) and increased risk of mortality at 90 days (OR 1.28, 95% CI 1.02–1.61) compared with the usual treatment. Conclusion: In patients with ischemic stroke, prehospital blood pressure reduction treatment was associated with a higher likelihood of poor functional outcome and an elevated risk of mortality.