Intensive versus standard lowering of blood pressure in the acute phase of intracranial haemorrhage: a systematic review and meta-analysis

Tiziana Carandini, Viviana Bozzano, Elio Scarpini, Nicola Montano, Monica Solbiati

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3 Citations (Scopus)

Abstract

The optimal target of blood pressure (BP) in the acute phase of intracranial haemorrhage (ICH) is still controversial. Our aim was to evaluate safety and efficacy of intensive BP lowering compared to standard BP treatment in ICH. We conducted a systematic review and meta-analysis of all available randomized controlled trials recruiting patients with elevated BP in acute spontaneous ICH to intensive or standard BP-lowering treatment. Our primary outcomes were 3-month mortality, disability (modified Rankin Scale 3–5) and combined death or disability. Secondary outcomes were early neurological deterioration at 24 h, substantial haematoma enlargement within 24–72 h and 3-month non-fatal serious adverse events. We included six studies for a total of 4385 patients (mean age 62 years, 62.3% men). No differences were detected between the two treatment groups in 3-month mortality (RR = 0.99, 95% CI 0.83–1.17), disability (RR = 0.96, 95% CI 0.89–1.03) and combined death and disability (RR = 0.97, 95% CI 0.90–1.03). The rate of patients with early neurological deterioration, substantial haematoma enlargement and non-fatal serious adverse events was similar in the two treatment groups (RR = 1.03, 95% CI 0.88–1.19, RR = 0.85, 95% CI 0.70–1.03, RR = 1.07, 95% CI 0.90–1.28, respectively). An intensive BP control in the acute phase of ICH is not beneficial and should not be recommended. Therefore, the systolic BP target of less than 140 mmHg that is now suggested by guidelines needs to be reconsidered.

Original languageEnglish
Pages (from-to)95-105
Number of pages11
JournalInternal and Emergency Medicine
Volume13
Issue number1
DOIs
Publication statusPublished - 2018

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Intracranial Hemorrhages
Meta-Analysis
Blood Pressure
Hematoma
Mortality
Therapeutics
Randomized Controlled Trials
Guidelines
Safety

Keywords

  • Blood pressure
  • Haemorrhagic stroke
  • Intensive
  • Intracranial bleeding
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

Cite this

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title = "Intensive versus standard lowering of blood pressure in the acute phase of intracranial haemorrhage: a systematic review and meta-analysis",
abstract = "The optimal target of blood pressure (BP) in the acute phase of intracranial haemorrhage (ICH) is still controversial. Our aim was to evaluate safety and efficacy of intensive BP lowering compared to standard BP treatment in ICH. We conducted a systematic review and meta-analysis of all available randomized controlled trials recruiting patients with elevated BP in acute spontaneous ICH to intensive or standard BP-lowering treatment. Our primary outcomes were 3-month mortality, disability (modified Rankin Scale 3–5) and combined death or disability. Secondary outcomes were early neurological deterioration at 24 h, substantial haematoma enlargement within 24–72 h and 3-month non-fatal serious adverse events. We included six studies for a total of 4385 patients (mean age 62 years, 62.3{\%} men). No differences were detected between the two treatment groups in 3-month mortality (RR = 0.99, 95{\%} CI 0.83–1.17), disability (RR = 0.96, 95{\%} CI 0.89–1.03) and combined death and disability (RR = 0.97, 95{\%} CI 0.90–1.03). The rate of patients with early neurological deterioration, substantial haematoma enlargement and non-fatal serious adverse events was similar in the two treatment groups (RR = 1.03, 95{\%} CI 0.88–1.19, RR = 0.85, 95{\%} CI 0.70–1.03, RR = 1.07, 95{\%} CI 0.90–1.28, respectively). An intensive BP control in the acute phase of ICH is not beneficial and should not be recommended. Therefore, the systolic BP target of less than 140 mmHg that is now suggested by guidelines needs to be reconsidered.",
keywords = "Blood pressure, Haemorrhagic stroke, Intensive, Intracranial bleeding, Meta-analysis, Systematic review",
author = "Tiziana Carandini and Viviana Bozzano and Elio Scarpini and Nicola Montano and Monica Solbiati",
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T1 - Intensive versus standard lowering of blood pressure in the acute phase of intracranial haemorrhage

T2 - a systematic review and meta-analysis

AU - Carandini, Tiziana

AU - Bozzano, Viviana

AU - Scarpini, Elio

AU - Montano, Nicola

AU - Solbiati, Monica

PY - 2018

Y1 - 2018

N2 - The optimal target of blood pressure (BP) in the acute phase of intracranial haemorrhage (ICH) is still controversial. Our aim was to evaluate safety and efficacy of intensive BP lowering compared to standard BP treatment in ICH. We conducted a systematic review and meta-analysis of all available randomized controlled trials recruiting patients with elevated BP in acute spontaneous ICH to intensive or standard BP-lowering treatment. Our primary outcomes were 3-month mortality, disability (modified Rankin Scale 3–5) and combined death or disability. Secondary outcomes were early neurological deterioration at 24 h, substantial haematoma enlargement within 24–72 h and 3-month non-fatal serious adverse events. We included six studies for a total of 4385 patients (mean age 62 years, 62.3% men). No differences were detected between the two treatment groups in 3-month mortality (RR = 0.99, 95% CI 0.83–1.17), disability (RR = 0.96, 95% CI 0.89–1.03) and combined death and disability (RR = 0.97, 95% CI 0.90–1.03). The rate of patients with early neurological deterioration, substantial haematoma enlargement and non-fatal serious adverse events was similar in the two treatment groups (RR = 1.03, 95% CI 0.88–1.19, RR = 0.85, 95% CI 0.70–1.03, RR = 1.07, 95% CI 0.90–1.28, respectively). An intensive BP control in the acute phase of ICH is not beneficial and should not be recommended. Therefore, the systolic BP target of less than 140 mmHg that is now suggested by guidelines needs to be reconsidered.

AB - The optimal target of blood pressure (BP) in the acute phase of intracranial haemorrhage (ICH) is still controversial. Our aim was to evaluate safety and efficacy of intensive BP lowering compared to standard BP treatment in ICH. We conducted a systematic review and meta-analysis of all available randomized controlled trials recruiting patients with elevated BP in acute spontaneous ICH to intensive or standard BP-lowering treatment. Our primary outcomes were 3-month mortality, disability (modified Rankin Scale 3–5) and combined death or disability. Secondary outcomes were early neurological deterioration at 24 h, substantial haematoma enlargement within 24–72 h and 3-month non-fatal serious adverse events. We included six studies for a total of 4385 patients (mean age 62 years, 62.3% men). No differences were detected between the two treatment groups in 3-month mortality (RR = 0.99, 95% CI 0.83–1.17), disability (RR = 0.96, 95% CI 0.89–1.03) and combined death and disability (RR = 0.97, 95% CI 0.90–1.03). The rate of patients with early neurological deterioration, substantial haematoma enlargement and non-fatal serious adverse events was similar in the two treatment groups (RR = 1.03, 95% CI 0.88–1.19, RR = 0.85, 95% CI 0.70–1.03, RR = 1.07, 95% CI 0.90–1.28, respectively). An intensive BP control in the acute phase of ICH is not beneficial and should not be recommended. Therefore, the systolic BP target of less than 140 mmHg that is now suggested by guidelines needs to be reconsidered.

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KW - Haemorrhagic stroke

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KW - Intracranial bleeding

KW - Meta-analysis

KW - Systematic review

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