Systematic ReviewResearchWorkflow

Intensive blood-pressure lowering after stroke reperfusion probably increased mortality without meaningful functional benefit

The Cochrane database of systematic reviews (PubMed)Jul 14, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A Cochrane review of nine randomized trials involving 4,381 adults found that intensive systolic targets below 160 mmHg after ischemic-stroke reperfusion produced no clinically meaningful functional or hemorrhage benefit and probably increased all-cause mortality.

What NurseJet pulled from the source

This Cochrane review compared intensive systolic blood-pressure targets below 160 mmHg with conventional targets, generally below 180 mmHg, after thrombolysis or endovascular thrombectomy for ischemic stroke. Nine randomized trials included 4,381 participants. Intensive management produced little to no clinically meaningful difference in functional outcomes and did not change the risk of any intracranial hemorrhage (RR 0.99, 95% CI 0.87 to 1.14). It probably increased all-cause mortality (RR 1.19, 95% CI 1.08 to 1.32) and probably reduced the proportion of participants with favorable neurologic status, although the estimate included the possibility of little difference. The review does not support assuming that a lower post-reperfusion target is safer or more effective for every patient.

Why this matters for nurses

Stroke and critical-care nurses repeatedly measure blood pressure, assess neurologic status, administer ordered antihypertensives, and escalate deviations after reperfusion. This review matters because it challenges the intuitive assumption that pushing systolic pressure lower than conventional targets necessarily improves recovery.

Bedside takeaway

Be aware that intensive systolic targets below 160 mmHg after stroke reperfusion probably increased mortality without meaningful functional or hemorrhage benefit.

How This Applies in Practice

Use this when: Caring for an adult after thrombolysis or endovascular thrombectomy under an approved post-reperfusion blood-pressure pathway.

On your shift

Confirm the ordered systolic target and treatment threshold instead of assuming that the most intensive target is preferred.
Trend blood pressure alongside neurologic assessments and promptly communicate out-of-range values or deterioration through the stroke escalation pathway.

Keep in mind: The review compared several intensive targets and does not define one target for every patient. Follow facility protocol and patient-specific provider orders.

Key takeaways

The review included nine randomized trials and 4,381 adults after thrombolysis or endovascular thrombectomy.
Intensive systolic targets below 160 mmHg did not produce a clinically meaningful functional benefit.
Any intracranial hemorrhage was similar with intensive and conventional management.
Intensive management probably increased all-cause mortality, with a pooled risk ratio of 1.19.

Practice implications

Use the prescribed post-reperfusion target and the facility's stroke protocol rather than treating a lower systolic pressure as automatically better. Pair blood-pressure surveillance with neurologic reassessment and promptly communicate out-of-range values or clinical deterioration to the stroke team.

Limitations & cautions

The intensive targets varied across trials, including thresholds below 120, 140, and 160 mmHg; seven studies involved thrombectomy and two involved thrombolysis. Studies were mainly from upper-middle- and high-income countries, and certainty ranged from high to very low across outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

Public citations are filtered to exact credible source pages. Homepage-only or invalid links stay in admin review and are not shown here.

The Cochrane database of systematic reviews (PubMed)

The Cochrane database of systematic reviews (PubMed). Blood pressure management in reperfused ischemic stroke.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42445947/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

Related briefs

More updates for this clinical area

Back to Discover

Trauma, violence & abuse (PubMed)Oct 17, 2026Systematic Review

A systematic review and meta-analysis of 20 emergency department studies encompassing 7,498 women found intimate partner violence was associated with a three-fold increased risk of suicide attempt, with psychological violence showing a stronger association than physical violence.

Emergency PsychAI summaryReview source

Systematic ReviewResearchWorkflowQuality ImprovementAI summary · original source linked below

Women experiencing intimate partner violence (IPV) and acute suicidality frequently seek medical evaluation in emergency departments (EDs), but the intersection between these two acute presentations is often overlooked during fast-paced triage. This systematic review, meta-analysis, and narrative synthesis synthesized 20 ED-based studies comprising 7,498 women across three global databases. Investigators used random-effects models and evaluated study quality with the Joanna Briggs Institute (JBI) checklist. Overall, 22% (95% CI: 11%–36%) of women presenting to the ED for suicide-related care had a history of physical IPV, while 13% (95% CI: 8%–18%) of women with known IPV histories reported active suicidality. A history of IPV was associated with a three-fold increase in the risk of suicide attempt (risk ratio [RR] 3.00; 95% CI: 1.39–6.47). Notably, psychological IPV demonstrated a stronger association with suicide risk (RR 3.23; 95% CI: 1.68–6.19) than physical IPV alone (RR 2.00; 95% CI: 1.26–3.17).

Key takeaways

Systematic review synthesized 20 emergency department studies encompassing 7,498 women.
Nearly 1 in 4 women (22%; 95% CI: 11%–36%) presenting to the ED with suicidality had experienced physical IPV.
IPV was associated with a three-fold higher risk of suicide attempt (RR 3.00; 95% CI: 1.39–6.47).
Psychological IPV showed a higher risk ratio for suicide attempts (RR 3.23; 95% CI: 1.68–6.19) than physical IPV (RR 2.00; 95% CI: 1.26–3.17).

Why this matters on shift

Emergency nurses are the primary healthcare professionals conducting universal triage, suicide risk screening (e.g., C-SSRS), and domestic violence assessments. Recognizing that nearly one-quarter of suicidal female presentations co-occur with IPV—and that non-physical, psychological abuse carries an even higher relative risk for suicide attempt—demands that ED nursing assessments integrate trauma-informed safety planning rather than treating suicidality and relationship violence in isolation.

Bedside takeaway

In an ED meta-analysis of 7,498 women, intimate partner violence tripled suicide attempt risk (RR 3.00), with psychological IPV (RR 3.23) linked more strongly than physical IPV (RR 2.00).

Nursing implications

Conduct routine IPV and suicide screenings privately away from companions or visitors, assess for emotional and psychological coercion even when physical injury is absent, and connect patients showing combined risk immediately to hospital social work, victim advocacy, and safe crisis intervention pathways.

Limitations & cautions

High between-study heterogeneity across meta-analytic models (I² > 75%); high risk of bias identified in half of the included primary studies; relied largely on cross-sectional self-reported survey measures.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Trauma, violence & abuse (PubMed). Intimate Partner Violence and Suicide Risk among Women Presenting to Emergency Departments: A Systematic Review, Meta-Analysis, and Narrative Synthesis.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Western journal of nursing research (PubMed)Oct 15, 2026Systematic Review

A systematic review and meta-analysis of 38 studies including 19,033 patients identified clinical severity scales—specifically Modified Fisher grade and Fisher grade—and hemodynamic status as the strongest predictors of cerebral vasospasm following subarachnoid hemorrhage.

Emergency ICUAI summaryReview source

Systematic ReviewResearchQuality ImprovementAI summary · original source linked below

Cerebral vasospasm is a severe complication of aneurysmal subarachnoid hemorrhage (SAH) that frequently precipitates delayed cerebral ischemia and increases patient mortality. To clarify clinical predictors and inform intensive care nursing assessments, investigators conducted a systematic review and meta-analysis across eight databases through August 2024, evaluating study quality with the Joanna Briggs Institute checklist and Risk of Bias 2.0 tool. Across 38 included studies (27 in the meta-analysis) encompassing 19,033 patients, clinical severity metrics showed the strongest association with cerebral vasospasm: Modified Fisher grade (odds ratio [OR] 2.88; 95% CI, 2.04–4.07), Fisher grade (OR 2.27; 95% CI, 1.91–2.69), and hemodynamic status (OR 2.56; 95% CI, 1.17–5.59). Aneurysm-related characteristics and comorbid conditions were also linked to increased vasospasm risk, whereas clinical biomarkers and inflammatory markers demonstrated comparatively smaller effect sizes.

Key takeaways

Systematic review and meta-analysis synthesized 38 studies (27 in meta-analysis) encompassing 19,033 patients after subarachnoid hemorrhage.
Radiographic and clinical severity scales showed the strongest association with cerebral vasospasm: Modified Fisher grade (OR 2.88; 95% CI, 2.04–4.07) and Fisher grade (OR 2.27; 95% CI, 1.91–2.69).
Hemodynamic instability was strongly associated with vasospasm risk (OR 2.56; 95% CI, 1.17–5.59).
Aneurysm features and comorbidities also increased risk, while clinical biomarkers and inflammatory markers demonstrated smaller effect sizes.

Why this matters on shift

Neurocritical care nurses are the first line of defense in detecting subtle neurological deterioration and hemodynamic shifts in patients hospitalized for subarachnoid hemorrhage. Understanding that initial Fisher grade and hemodynamic status carry the highest statistical odds for vasospasm reinforces rigorous serial neurological scoring and strict blood pressure monitoring during the peak vasospasm window.

Bedside takeaway

In a meta-analysis of 19,033 SAH patients, Modified Fisher grade (OR 2.88), Fisher grade (OR 2.27), and hemodynamic status (OR 2.56) were the strongest predictors of cerebral vasospasm.

Nursing implications

Identify admission Fisher or Modified Fisher scores during shift handoff, maintain strict hemodynamic parameters per provider orders, and immediately escalate focal neurological deficits, altered sensorium, or transcranial Doppler velocity increases.

Limitations & cautions

Synthesized observational studies with heterogeneous definitions and reporting standards; meta-analysis reflects statistical associations rather than prospective causal prediction models; abstract does not detail specific individual biomarker cutoff values.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Western journal of nursing research (PubMed). Key Predictors of Cerebral Vasospasm Following Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Clinical research in cardiology : official journal of the German Cardiac Society (PubMed)Sep 28, 2026Research Article

A prespecified sex-specific secondary analysis of the PUSH-AHF trial in 310 patients found natriuresis-guided diuretic therapy increased 24-hour sodium excretion and reduced 180-day mortality or heart failure readmission in men, but not in women.

Telemetry ICUAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Natriuresis-guided loop diuretic titration uses spot urinary sodium measurements to tailor decongestive therapy in acute heart failure (AHF). In this sex-specific analysis of the randomized PUSH-AHF trial, investigators evaluated 310 patients (45% women) assigned to natriuresis-guided therapy versus standard of care. In men, natriuresis-guided therapy produced significantly greater mean 24-hour total natriuresis compared with standard care (443 vs 354 mmol, p = 0.004), whereas women showed no significant difference between treatment arms (357 vs 336 mmol, p = 0.533; adjusted p-interaction = 0.276). Notably, the median 24-hour natriuretic response per milligram of loop diuretic (bumetanide equivalents) was significantly lower in women receiving natriuresis-guided therapy than standard care (23 vs 52 mmol/mg, p = 0.001), while no difference was observed in men (38 vs 45 mmol/mg, p = 0.337; adjusted p-interaction = 0.009). Clinically, natriuresis guidance was associated with a 49% lower risk of 180-day all-cause mortality or HF rehospitalization in men (adjusted HR 0.51; 95% CI, 0.30–0.86; p = 0.011), but showed no benefit in women (adjusted HR 1.40; 95% CI, 0.67–2.91; p = 0.368; adjusted p-interaction = 0.026).

Key takeaways

Sex-specific analysis of the PUSH-AHF randomized trial evaluated 310 patients (45% women) with acute heart failure.
In men, natriuresis-guided therapy increased 24-hour urinary sodium excretion (443 vs 354 mmol, p = 0.004) and reduced 180-day mortality/rehospitalization by 49% (adjusted HR 0.51, p = 0.011).
In women, natriuresis guidance did not increase total natriuresis (357 vs 336 mmol, p = 0.533) or improve 180-day clinical outcomes (adjusted HR 1.40, p = 0.368; p-interaction = 0.026).
Women in the guided arm exhibited a blunted natriuretic response per milligram of loop diuretic (23 vs 52 mmol/mg bumetanide, p = 0.001).

Why this matters on shift

Cardiology and telemetry nurses frequently manage intensive loop diuretic infusions and collect spot urinary sodium samples during acute decompensated heart failure admissions. These findings demonstrate that diuretic responsiveness and natriuresis-guided protocols may operate differently by biological sex, warning clinicians that intensifying diuretic doses based solely on spot sodium targets may not yield uniform decongestive or prognostic benefits across all patient groups.

Bedside takeaway

In the PUSH-AHF trial (310 patients), natriuresis-guided diuretic therapy reduced 180-day mortality/readmission in men (aHR 0.51) but showed no benefit in women (aHR 1.40; p-interaction=0.026).

Nursing implications

Collect urine samples for spot sodium strictly at ordered intervals during acute decongestion, maintain accurate intake/output records, monitor serum electrolytes and renal function closely during diuretic uptitration, and recognize that blunted urinary sodium output in female patients may reflect altered pharmacodynamics rather than simple noncompliance with fluid restrictions.

Limitations & cautions

Post-hoc subgroup analysis of a randomized trial with limited sample size (n = 310, including 139 women); findings are hypothesis-generating and require prospective validation in sex-stratified clinical trials before modifying clinical guidelines.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Clinical research in cardiology : official journal of the German Cardiac Society (PubMed). Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Meta-analysis of 20 emergency department studies links intimate partner violence to three-fold higher suicide attempt risk

Meta-analysis of 19,033 SAH patients identifies clinical severity and hemodynamics as top predictors of cerebral vasospasm

PUSH-AHF trial analysis finds natriuresis-guided diuretic therapy reduces 180-day events in men but not women with acute heart failure