Antihypertensive Drugs for Secondary Prevention After Ischemic Stroke or Transient Ischemic AttackA Systematic Review and Meta-Analysis

Giorgio B. Boncoraglio, Cinzia Del Giovane, Irene Tramacere

Stroke. 2021 Apr 27; STROKEAHA120031945. doi: 10.1161/STROKEAHA.120.031945.

Selezionato dal Lettore: Giacomo Sferruzza - IRCCS Ospedale San Raffaele - Milano

MOTIVATION: In this systematic review and meta-analysis Boncoraglio and collogues analysis the current evidence on pharmacological blood pressure management for secondary prevention in patients with ischemic stroke or transient ischemic attack (TIA). Even though it is a crucial point in management of patients affected by ischemic stroke, current guidelines are based on meta-analysis including both ischemic and hemorrhagic stroke patients.
For this reason, this work aims to performed a more targeted investigation focusing only on ischemic stroke and TIA. 
The authors searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials for relevant papers and selected for the analysis eight studies, including more than thirty thousand patients. The meta-analysis was performed using a pairwise random-effects model and potential sources of heterogeneity were explored through subgroup analysis.  The analysis shown that blood pressure-lowering drugs in patients with ischemic stroke or transient ischemic attack is associated with a 1.9% risk of recurrence but not affect the overall mortality.
The importance of this article, in my opinion, is that it contributes to define the evidence based therapeutic approach to cerebrovascular secondary prevention.