SynthesisThe Cochrane database of systematic reviews2010
Vasoactive drugs for acute stroke.
Synthesis in The Cochrane database of systematic reviews, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 5 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Cerebrolysin for acute ischaemic stroke.The Cochrane database of systematic reviews · 2023Pooled it
- Cerebrolysin for acute ischaemic stroke.The Cochrane database of systematic reviews · 2020Pooled it
- The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019Guideline
- Pooled it
- Effects of early blood pressure lowering on early and long-term outcomes after acute stroke: an updated meta-analysis.PloS one · 2014Pooled it
- Trial
- Computing within-study covariances, data visualization, and missing data solutions for multivariate meta-analysis with metavcov.Frontiers in psychology · 2023Article
- Pressor therapy in acute ischaemic stroke: an updated systematic review.European stroke journal · 2022Review
- Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke.Stroke and vascular neurology · 2017Article
- Blood Pressure and Penumbral Sustenance in Stroke from Large Vessel Occlusion.Frontiers in neurology · 2017Review
- Change in Systolic Blood Pressure During Stroke, Functional Status, and Long-Term Mortality in an Elderly Population.American journal of hypertension · 2016Article
- Effect of Treatment Delay, Stroke Type, and Thrombolysis on the Effect of Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome after Acute Stroke: A Systematic Review and Meta-Analysis of Individual Patient from Randomised Trials.Stroke research and treatment · 2016Article
- The choice of prior distribution for a covariance matrix in multivariate meta-analysis: a simulation study.Statistics in medicine · 2015Article
- Control of blood pressure in hypertensive neurological emergencies.Current hypertension reports · 2014Review
- Estimating within-study covariances in multivariate meta-analysis with multiple outcomes.Statistics in medicine · 2013Article
- Unsolved issues in the management of high blood pressure in acute ischemic stroke.International journal of hypertension · 2013Article
Corrections and comments
- Update of
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIt is unclear whether blood pressure (BP) should be altered actively during the acute phase of stroke.
objectivesTo assess the effect of lowering or elevating BP in people with acute stroke, and the effect of different vasoactive drugs on BP in acute stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched June 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2009), MEDLINE (1966 to October 2009), EMBASE (1980 to October 2009), and Science Citation Index (1981 to October 2009). SELECTION CRITERIA: Randomised trials of interventions that would be expected, on pharmacological grounds, to alter BP in patients within one week of the onset of acute stroke. DATA COLLECTION AND ANALYSIS: Two review authors independently applied the trial inclusion criteria, assessed trial quality, and extracted data. MAIN
resultsWe identified 131 trials involving in excess of 18,000 patients; a further 13 trials are ongoing. We obtained data for 43 trials (7649 patients). Among BP-lowering trials, beta receptor antagonists lowered BP (early systolic BP (SBP) mean difference (MD) -6.1 mmHg, 95% CI -11.4 to -0.9; late SBP MD -4.9 mmHg, 95% CI -10.2 to 0.4; late diastolic BP (DBP) MD -4.5 mmHg, 95% CI -7.8 to -1.2). Oral calcium channel blockers (CCB) lowered BP (late SBP MD -3.2 mmHg, 95% CI -5.4 to -1.1; early DBP MD -2.5, 95% CI -5.6 to 0.7; late DBP MD -2.1, 95% CI -3.5 to -0.7). Nitric oxide donors lowered BP (early SBP MD -10.3 mmHg, 95% CI -17.6 to -3.0). Prostacyclin lowered BP (late SBP MD, -7.7 mmHg, 95% CI -15.6 to 0.2; late DBP MD -3.9 mmHg, 95% CI -8.1 to 0.4). Among BP-increasing trials, diaspirin cross-linked haemoglobin (DCLHb) increased BP (early SBP MD 15.3 mmHg, 95% CI 4.0 to 26.6; late SBP MD 15.9 mmHg, 95% CI 1.8 to 30.0). None of the drug classes significantly altered outcome apart from DCLHb which increased combined death or dependency (odds ratio (OR) 5.41, 95% CI 1.87 to 15.64). AUTHORS'
conclusionsThere is not enough evidence to evaluate reliably the effect of altering BP on outcome after acute stroke. However, treatment with DCLHb was associated with poor clinical outcomes. Beta receptor antagonists, CCBs, nitric oxide, and prostacyclin each lowered BP during the acute phase of stroke. In contrast, DCLHb increased BP.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.