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October 21, 2014; 83 (17) Article

Intensive blood pressure reduction in acute intracerebral hemorrhage

A meta-analysis

Georgios Tsivgoulis, Aristeidis H. Katsanos, Kenneth S. Butcher, Efstathios Boviatsis, Nikos Triantafyllou, Ioannis Rizos, Andrei V. Alexandrov
First published September 19, 2014, DOI: https://doi.org/10.1212/WNL.0000000000000917
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Abstract

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 (I2 = 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.

GLOSSARY

AHA=
American Heart Association;
BP=
blood pressure;
CI=
confidence interval;
ICH=
intracerebral hemorrhage;
ICH ADAPT=
Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial;
INTERACT=
Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial;
MAP=
mean arterial pressure;
NIHSS=
NIH Stroke Scale;
OR=
odds ratio;
RCT=
randomized controlled trial;
SBP=
systolic blood pressure;
SMD=
standardized mean difference

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at Neurology.org

  • Received May 13, 2014.
  • Accepted in final form July 28, 2014.
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