{"id":"a3fb55576706","type":"article","url":"https://hartvaat.nl/2026/10/15/vroege-bloeddrukverlaging-bij-acute-ischemische-stroke-verbetert-functioneel-her/","title":"Vroege bloeddrukverlaging bij acute ischemische stroke verbetert functioneel herstel niet — meta-analyse","title_en":"Early antihypertensive therapy in acute ischemic stroke: A Meta-analysis of randomized controlled trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the neurological sciences","doi":"10.1016/j.jns.2026.126125","source_url":"https://doi.org/10.1016/j.jns.2026.126125","authors":["Gabriela Argollo Fernandes","Lorrany Larisse Costa Rodrigues","Maria Eduarda Sulzbacher E Lima","Ahmad Alareed"],"significance":6,"published":"2026-08-18","source_date":"2026-10-15","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"A meta-analysis of seven RCTs involving 15,521 patients found that initiating antihypertensive therapy within 48 hours of an acute ischemic stroke effectively lowers blood pressure but does not improve mortality or functional outcomes. Pooled risk ratios for all-cause mortality (RR 0.97) and death or functional dependency (RR 1.01) showed no significant benefit compared with placebo or usual care. These results reinforce current guidelines against routine early blood pressure lowering in the general acute stroke population and highlight the need for individualized hemodynamic management.","created":"2026-08-11T01:07:04Z","updated":"2026-08-11T01:07:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een meta-analyse van zeven RCTs (15.521 patiënten) toont aan dat het binnen 48 uur na een acute ischemische stroke starten met antihypertensiva de bloeddruk wel verlaagt, maar niet leidt tot minder sterfte of een beter functioneel herstel. De gepoolde risico’s voor overlijden (RR 0,97) en overlijden of functionele afhankelijkheid (RR 1,01) verschilden niet significant van placebo of standaardzorg. Deze bevindingen ondersteunen het huidige advies om agressieve vroege bloeddrukverlaging bij de algemene AIS-patiënt te vermijden en benadrukken het belang van individuele hemodynamische afwegingen.","abstract_original":"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."}