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.

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