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Published on: October 15, 2021
Intensive blood pressure reduction in acute intracerebral hemorrhage: a meta-analysis
Georgios Tsivgoulis1, Aristeidis H Katsanos2, Kenneth S Butcher2
1From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece. tsivgoulisgiorg@yahoo.gr.
Objective:
The aim of the present systematic review and meta-analysis was to evaluate the safety and efficacy of intensive blood pressure (BP) reduction in patients with acute-onset intracerebral hemorrhage (ICH) using data from randomized controlled trials.
Methods:
We conducted a systematic review and meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines of all available randomized controlled trials that randomized patients with acute ICH to either intensive or guideline BP-reduction protocols.
Results:
We identified 4 eligible studies, including a total of 3,315 patients (mean age 63.4 ± 1.4 years, 64% men). Death rates were similar between patients randomized to intensive BP-lowering treatment and those receiving guideline BP-lowering treatment (odds ratio = 1.01, 95% confidence interval: 0.83-1.23; p = 0.914). Intensive BP-lowering treatment tended to be associated with lower 3-month death or dependency (modified Rankin Scale grades 3-6) compared with guideline treatment (odds ratio = 0.87, 95% confidence interval: 0.76-1.01; p = 0.062). No evidence of heterogeneity between estimates (I(2) = 0%; p = 0.723), or publication bias in the funnel plots (p = 0.993, Egger statistical test), was detected. Intensive BP reduction was also associated with a greater attenuation of absolute hematoma growth at 24 hours (standardized mean difference ± SE: -0.110 ± 0.053; p = 0.038).
Conclusions:
Our findings indicate that intensive BP management in patients with acute ICH is safe. Fewer intensively treated patients had unfavorable 3-month functional outcome although this finding did not reach significance. Moreover, intensive BP reduction appears to be associated with a greater attenuation of absolute hematoma growth at 24 hours.
