Deans' stroke musings: Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: Clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, February 26, 2017

Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: Clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials

But this to think about:

Don't go too low with blood pressure in hypertensive CAD patients

https://www.mdlinx.com/internal-medicine/medical-news-article/2017/02/23/intracerebral-haemorrhage-intensive-blood-pressure/7065557/?

Journal of Neurology, Neurosurgery & Psychiatry, 02/23/2017 Boulouis G, et al.

A meta–analysis of randomised controlled trials (RCTs) was performed to evaluate whether intensive blood pressure (BP) lowering in patients with acute intracerebral haemorrhage (ICH) is safe and effective in improving clinical outcomes. Intensive acute BP lowering is safe for patients with acute ICH similar to those included in RCTs and without contraindication to acute BP treatment, however, does not seem to provide an incremental clinical benefit in terms of functional outcomes. The effect of intensive BP lowering on significant haematoma expansion at 24 hours warrants further investigation.

Methods

PubMed, EMBASE and the Cochrane databases were searched for relevant RCTs and calculated pooled OR for 3-month mortality (safety outcome) and 3-month death or dependency (modified Rankin Scale (mRs) ≥3;efficacy outcome), in patients with acute ICH randomised to either intensive BP-lowering or standard BP-lowering treatment protocols.
Also, the authors examined the association between treatment arm and ICH expansion at 24 hours.
They used random effects models with DerSimonian-Laird weights.

Results

The authors pooled 5 eligible studies including 4360 patients with acute ICH in meta-analysis.
Between patients randomised to intensive BP-lowering treatment and standard BP-lowering treatment, the risk of 3-month mortality was similar (OR: 0.99; 95% CI: 0.82 to 1.20, p=0.909).
Compared with standard treatment, intensive BP-lowering treatment demonstrated a (non-significant) trend for an association with lower 3-month death or dependency risk (OR: 0.91; 95% CI: 0.80 to 1.02), p=0.106).
Compared with standard treatment, intensive BP reduction was associated with a trend for lower risk of significant ICH expansion (OR: 0.82; 95% CI: 0.68 to 1.00, p=0.056), particularly in larger RCTs.

Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report