Continuing or Temporarily Stopping Pre-Stroke Antihypertensive Medication in Acute Stroke: An Individual Patient Data Meta-Analysis

Over 50% of patients are already taking blood pressure-lowering therapy on hospital admission for acute stroke. An individual patient data meta-analysis from randomized controlled trials was undertaken to determine the effect of continuation versus temporarily stopping pre-existing antihypertensive medication in acute stroke. Key databases were searched for trials against the following inclusion criteria: randomized design; stroke onset ≤48 hours; investigating the effect of continuation versus stopping pre-stroke antihypertensive medication; follow up of ≥2 weeks. Two randomized controlled trials were identified and included in this meta-analysis of individual patient data from 2860 patients ≤48 hours of acute stroke. Risk of bias in each study was low. In adjusted logistic regression and multiple regression analyses (using random effects), we found no significant association between continuation of pre-stroke antihypertensive therapy (versus stopping) and risk of death or dependency at final follow-up: Odds Ratio 0.96 (95% Confidence Intervals 0.80 to 1.14). No significant associations were found between continuation (versus stopping) of therapy and secondary outcomes at final follow-up. Analyses for death and dependency in pre-specified subgroups revealed no significant associations with continuation versus temporarily stopping therapy, with the exception of patients randomised ≤12 hours, in whom a difference favoring stopping treatment met statistical significance. We found no significant benefit with continuation of antihypertensive treatment in the acute stroke period. Therefore, there is no urgency to administer pre-existing antihypertensive therapy in the first few hours or days following stroke, unless indicated for other comorbid conditions.