Blood Pressure Management for Acute Intracerebral Hemorrhage: A Meta-Analysis

Inconsistent data from the randomized trials ignites controversy on intensive blood pressure (BP) reduction for acute intracerebral hemorrhage (ICH). This study aims to examine the association between BP lowering and clinical outcomes among patients with acute ICH. We conducted this meta-analysis based on the published randomized controlled trials (RCTs). Data were included from 6 RCTs involving 4412 patients. No significant improvements were observed in hematoma growth at 24 hours, neurologic improvement at 24 hours, hypotension at 72 hours, death or dependency at 90 days, mortality at 90 days, and serious adverse events at 90 days between intensive and conservative BP lowering groups. High heterogeneity was observed between estimates in hematoma growth (I ² = 49). Univariate meta-regression and subgroup analysis showed that intensive BP lowering showed a significant decrease in hematoma growth in age ≤62 years, time from symptoms onset to treatment ≤6 hours, baseline hematoma volume ≤15 mL, and combined intraventricular hemorrhage ≤25% subgroups. In conclusion, intensive BP management in patients with ICH is safe. Intensive BP lowering could reduce hematoma growth in those patients (≤62 years old) with ICH volume less than 15 mL receiving BP management within 6 hours after randomization.