Early antihypertensive therapy in acute ischemic stroke: A Meta-analysis of randomized controlled trials
In brief
Early blood pressure lowering after ischemic stroke does not cut death or disability
A meta-analysis of seven randomized trials with 15,500 patients found that starting antihypertensive drugs within 48 hours lowered blood pressure modestly but did not change overall mortality, death or functional dependency, major vascular events, or recurrent stroke. The results suggest routine early BP reduction should not be standard for non-reperfused stroke patients, highlighting the need for individualized management.
- Journal
- Journal of the neurological sciences (Q1)
- Published
- 31 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Gabriela Argollo Fernandes, Lorrany Larisse Costa Rodrigues, Maria Eduarda Sulzbacher E Lima, Ahmad Alareed
- PMID
- 42546365
- DOI
- 10.1016/j.jns.2026.126125
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 9 August 2026): Early antihypertensive therapy, stroke outcomes
- Picked for Physiology (medical) (top studies of the week, 9 August 2026).
- Picked for Neurology (clinical) (top studies of the week, 9 August 2026).
- Picked for Public Health, Environmental and Occupational Health (top studies of the week, 9 August 2026).
Abstract
OBJECTIVE: To evaluate whether early initiation of antihypertensive therapy (AHT) improves clinical outcomes in acute ischemic stroke (AIS) compared with placebo or usual care. METHODS: We systematically searched PubMed, Embase, and Cochrane CENTRAL for randomized controlled trials (RCTs) evaluating early AHT, defined as blood pressure-lowering treatment initiated within 48 h of symptom onset. Primary outcomes were all-cause mortality and death or functional dependency (modified Rankin Scale score ≥ 3). Secondary outcomes included major vascular events, recurrent stroke, and blood pressure (BP) changes. Pooled risk ratios (RRs) and mean differences (MDs) were estimated using random-effects models. RESULTS: Seven RCTs including 15,521 patients were analyzed. Early AHT was not associated with significant differences in all-cause mortality (RR, 0.97; 95% CI, 0.71-1.31), death or functional dependency (RR, 1.01; 95% CI, 0.92-1.12), major vascular events (RR, 0.89; 95% CI, 0.63-1.26), or recurrent stroke (RR, 0.90; 95% CI, 0.49-1.64). Therapy lowered BP at 24 h (systolic BP: MD, -8.58 mmHg; 95% CI, -9.87--7.30; diastolic BP: MD, -4.00 mmHg; 95% CI, -4.45--3.54). CONCLUSION: In AIS, early AHT produces short-term BP reduction but was not associated with improvement in functional outcomes, mortality, or recurrent stroke. These findings do not support routine early BP lowering in the general AIS population not undergoing reperfusion therapy and reinforce the need for individualized hemodynamic management strategies.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.