关键词: 卒中, 降压, 强化降压, 二级预防, Meta分析

Abstract:

Objective To assess the efficacy and safety of different blood pressure target on secondary stroke prevention. Methods We searched English and Chinese databases, including PubMed, Embase, Cochrane, Wanfang database, China National Knowledge Internet (CNKI), Chongqing VIP, and China Biology Medicine disc (CBM). The search time of database was up to June 1, 2020. Inclusion criteria: in randomized controlled trials (RCT) of stroke recurrence prevention, we included trials comparing BPLDs group (blood pressure-lowering drugs) versus control group (placebo or no treatment); we also included trials comparing intensive blood pressure lowering group with standard blood pressure lowering group (intensive blood pressure lowering defined as blood pressure <130/85 mmHg, standard blood pressure lowering defined as blood pressure <140/90 mmHg). Outcomes index: major vascular event, stroke, and myocardial infarction were used as efficacy outcomes. Vascular death and all-cause death were used as safety outcomes. Results Ten trials were included, with 39, 931 patients were included; of which, six studies were included in BPLDs group and the control group (35, 040 participants), and four studies were included intensive blood pressure lowering group and standard blood pressure lowering group (4, 891 participants). Compared with the control group, the pooled risk ratio (Risk Ratios, RR) of BPLDs was 0.80(95% confidence interval [CI] 0.69 to 0.93; P=0.003) for recurrent stroke, 0.85(95%CI 0.77 to 0.94; P=0.002) for vascular death in BPLDs group; there was no significant difference in the incidence of major vascular event, myocardial infarction and all-cause death between the two groups. Compared with standard blood pressure lowering group, the pooled RRs were 0.78 (95%CI 0.64 to 0.95; P=0.01) for recurrent stroke and 0.82 (95%CI 0.69 to 0.97; P=0.02) for major vascular event in intensive blood pressure lowering group. There was no significant difference in the incidence of myocardial infarction, vascular death and all-cause death between the two groups. Conclusion BPLDs reduce the risk of stroke recurrence and vascular death for stroke patients compared with no antihypertensive treatment. Intensive antihypertensive therapy for stroke patients can further reduce stroke recurrence and major vascular event compared with standard antihypertensive therapy.

Key words: stroke, antihypertensive treatment, intensive blood pressure lowering, secondary prevention, meta-analysis