Neuroanesthesia & neurocritical care
Impact of intravenous antihypertensive therapy on cerebral blood flow and neurocognition: a systematic review and meta-analysis
Authors' conclusion
Most i.v. antihypertensive agents do not significantly affect CBF in clinical dose ranges; however, nitroprusside and nitroglycerin can reduce CBF under specific clinical conditions.
Study context
- Population
- Normotensive, hypertensive, and intracranial pathology populations50 studies
- Comparison
- IV antihypertensive therapy effect on cerebral blood flow (CBF)
- Outcome
- Cerebral blood flow (CBF)
Methodological detailsstratified by population type, consciousness state, antihypertensive agent, and CBF measurement method
- Stratified by population type, consciousness state, antihypertensive agent, and CBF measurement method
Pooled result
As reported in the abstract
CBF in normotensive individuals without intracranial pathology
Intravenous antihypertensivedrug therapySMD (95% CI)
Significantly reduced CBF
−0.31(−0.51 to −0.11)
Nitroprusside and nitroglycerin in awake subjects
−0.80(−1.15 to −0.46)
- Median CBF decrease (nitroprusside and nitroglycerin, awake)
- 14% (IQR 13-16%)
- Median MAP reduction (nitroprusside and nitroglycerin, awake)
- 17% (IQR 9-22%)
Further pooled results
CBF, nitroprusside and nitroglycerin in awake normotensive subjects (subgroup)
| SMD (95% CI) | ||
|---|---|---|
| Nitroprusside and nitroglycerin | −0.80 (−1.15 to −0.46) | |
| −1.5−1−0.500.5Difference (linear scale) |
- CBF, nitroprusside and nitroglycerin in awake normotensive subjects (subgroup) — Median CBF decrease
- 14% (IQR 13-16%)
- CBF, nitroprusside and nitroglycerin in awake normotensive subjects (subgroup) — Median MAP reduction
- 17% (IQR 9-22%)
CBF, other antihypertensives in normotensives; hypertensive or intracranial pathology patients (subgroups)
- No significant effects on CBF when median MAP reduction was ∼20%
Correlation of MAP reduction with CBF change
- No correlation, supporting intact cerebral autoregulation
Safety
Neurocognitive changes (historical data)
- Neurocognitive changes when CBF fell to ∼30 ml 100 g-1 min-1
- 58% MAP reduction, 38% CBF reduction
Original publication
Impact of intravenous antihypertensive therapy on cerebral blood flow and neurocognition: a systematic review and meta-analysis. Br J Anaesth. Published 20 January 2025. doi:10.
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