Fulltext

Early lowering of blood pressure after acute intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

Moullaali TJ 1 , Wang X 1 , Sandset EC 2 , Woodhouse LJ 3 , Law ZK 3 , Arima H 4 Show all authors , Butcher KS 5 , Chalmers J 1 , Delcourt C 1 , Edwards L 6 , Gupta S 7 , Jiang W 8 , Koch S 9 , Potter J 10 , Qureshi AI 11 , Robinson TG 12 , Al-Shahi Salman R 13 , Saver JL 14 , Sprigg N 3 , Wardlaw JM 13 , Anderson CS 15 , Bath PM 3 , Blood Pressure in Acute Stroke (BASC) Investigators

Affiliations 

  • 1 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  • 2 Department of Neurology, Oslo University Hospital, Oslo, Norway
  • 3 Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
  • 4 Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
  • 5 Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
  • 6 Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  • 7 Department of Neurology, Army Hospital Research and Referral, New Delhi, India
  • 8 Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
  • 9 Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
  • 10 Stroke Research Group, Norfolk and Norwich University Hospital, UK
  • 11 Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO
  • 12 University of Leicester, Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Leicester, UK
  • 13 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  • 14 Department of Neurology and Comprehensive Stroke Center, UCLA, Los Angeles, California, USA
  • 15 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia canderson@georgeinstitute.org.au
J Neurol Neurosurg Psychiatry, 2022 01;93(1):6-13.
PMID: 34732465 DOI: 10.1136/jnnp-2021-327195

Abstract

OBJECTIVE: To summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).

METHODS: A prespecified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents versus placebo or intensive versus guideline BP-lowering targets for adults <7 days after ICH onset. The primary outcome was function (distribution of scores on the modified Rankin scale) 90 days after randomisation. Radiological outcomes were absolute (>6 mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted using generalised linear mixed models with prespecified covariables and trial as a random effect.

RESULTS: Of 7094 studies identified, 50 trials involving 11 494 patients were eligible and 16 (32.0%) shared patient-level data from 6221 (54.1%) patients (mean age 64.2 [SD 12.9], 2266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6-5.3). Active/intensive BP-lowering interventions had no effect on the primary outcome compared with placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95% CI 0.88 to 1.06; p=0.50), but there was significant heterogeneity by strategy (pinteraction=0.031) and agent (pinteraction<0.0001). Active/intensive BP-lowering interventions clearly reduced absolute (>6 ml, adjusted OR 0.75, 95%CI 0.60 to 0.92; p=0.0077) and relative (≥33%, adjusted OR 0.82, 95%CI 0.68 to 0.99; p=0.034) haematoma growth.

INTERPRETATION: Overall, a broad range of interventions to lower BP within 7 days of ICH onset had no overall benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent.

PROSPERO REGISTRATION NUMBER: CRD42019141136.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications