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

@article{Boulouis2017IntensiveBP,  title={Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials},  author={Grégoire Boulouis and Andrea Morotti and Joshua N. Goldstein and Andreas Charidimou},  journal={Journal of Neurology, Neurosurgery, and Psychiatry},  year={2017},  volume={88},  pages={339 - 345},  url={https://api.semanticscholar.org/CorpusID:25397701}}
For patients with acute ICH similar to those included in RCTs and without contraindication to acute BP treatment, intensive acute BP lowering is safe, but does not seem to provide an incremental clinical benefit in terms of functional outcomes.

103 Citations

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

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.

Intensive Blood Pressure Lowering for Intracerebral Hemorrhage: A Systematic Review and Updated Meta-analysis of Randomized Controlled Trials.

It is suggested that intensive BP lowering in ICH might be associated with improved functional outcomes and lower risks of death, disability, and hematoma enlargement, supporting its potential role in acute management.

Effects of Intensive Blood Pressure Reduction on Acute Intracerebral Hemorrhage: A Systematic Review and Meta-analysis

A meta-analysis of several recent RCTs found differences between intensive and standard BP lowering treatment groups in total mortality rates, unfavorable outcomes, hematoma expansion, neurologic deterioration, and severe hypotension were not significant.

Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review

Rapid lowering of systolic blood pressure by continuous administration of intravenous nicardipine during the initial 24 h in hyperacute intracerebral hemorrhage was associated with lower risks of hematoma expansion and 90-day death or disability without increasing serious adverse events.

Statistical analysis plan for pooled individual patient data from two landmark randomized trials (INTERACT2 and ATACH-II) of intensive blood pressure lowering treatment in acute intracerebral hemorrhage

To determine associations of early systolic blood pressure lowering parameters and outcomes in patients with a hypertensive response in acute intracerebral hemorrhage, two large, multicenter, randomized controlled trials are undertaken.

Early blood pressure management in hemorrhagic stroke: a meta-analysis

Intensive BP-lowering helps reduce hematoma enlargement in the early stage of acute hemorrhagic stroke, however, this observation did not translate into functional outcomes and further research is needed to clarify the specific scope and time of blood pressure reduction.

Regional Differences in the Response to Acute Blood Pressure Lowering After Cerebral Hemorrhage

This study provides Class II evidence that, for patients from East Asia with ICH, intensive blood pressure lowering significantly reduces the risk of hematoma expansion.

Blood Pressure Variability and Outcome in Patients with Acute Nonlobar Intracerebral Hemorrhage following Intensive Antihypertensive Treatment

The MAC of SBP is associated with hematoma growth, and SD and COV are correlated with 3-month poor outcome in patients with supratentorial nonlobar ICH, suggesting sustained SBP control, with a reduction in SBP variability is essential to reinforce the beneficial effect of intensive antihypertensive treatment.
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31 References

Blood pressure variability and outcome after acute intracerebral haemorrhage : a post-hoc analysis of INTERACT 2 , a randomised controlled trial *

A large number of adults with spontaneous intracerebral haemorrhage and high systolic blood pressure without a definite indication or contraindication to early intensive treatment to reduce blood pressure were enrolled in INTERACT2.

High blood pressure in acute stroke and subsequent outcome: a systematic review.

High BP in acute ischemic stroke or PICH is associated with subsequent death, death or dependency, and death or deterioration, and moderate lowering of BP might improve outcome.

Optimal achieved blood pressure in acute intracerebral hemorrhage

This study provides Class I evidence that the effect of intensive BP lowering on physical function is not influenced by baseline BP, and target SBP level of 130–139 mm Hg is likely to provide maximum benefit in acute ICH.

Rapid Blood Pressure Reduction in Acute Intracerebral Hemorrhage: Feasibility and Safety

A more aggressive reduction of acute hypertension after ICH does not increase the rate of neurological deterioration even when treatment is initiated within hours of symptom onset, and lowering BP aggressively did not affect hematoma and edema expansion.

Intensive blood-pressure lowering in patients with acute cerebral hemorrhage.

To determine the therapeutic benefit of intensive BP treatment compared to standard BP treatment in reducing death and disability after 3 months of follow-up among patients with ICH treated within 4.5 hours from onset of symptoms.

Interpretation and Implementation of Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT II).

There is discordance between the proposed and observed therapeutic benefit of intensive SBP reduction in INTERACT II, and without a more focused therapeutic measure, it is difficult to define the most optimal antihyptersensive therapy based on INTER ACT II findings.

Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage.

In patients with intracerebral hemorrhage, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability, and an ordinal analysis of modified Rankin scores indicated improved functional outcomes with intensive loweringof blood pressure.

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