RT Journal Article
SR Electronic
T1 Early lowering of blood pressure after acute intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 6
OP 13
DO 10.1136/jnnp-2021-327195
VO 93
IS 1
A1 Moullaali, Tom J
A1 Wang, Xia
A1 Sandset, Else Charlotte
A1 Woodhouse, Lisa J
A1 Law, Zhe Kang
A1 Arima, Hisatomi
A1 Butcher, Kenneth S
A1 Chalmers, John
A1 Delcourt, Candice
A1 Edwards, Leon
A1 Gupta, Salil
A1 Jiang, Wen
A1 Koch, Sebastian
A1 Potter, John
A1 Qureshi, Adnan I
A1 Robinson, Thompson G
A1 Al-Shahi Salman, Rustam
A1 Saver, Jeffrey L
A1 Sprigg, Nikola
A1 Wardlaw, Joanna M
A1 Anderson, Craig S
A1 Bath, Philip M
YR 2022
UL http://jnnp.bmj.com/content/93/1/6.abstract
AB 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.Data are available in a public, open access repository. Data are available on reasonable request. Requests for sharing of de-identified IPD from individual trials used in these analyses should be directed to the corresponding author of the individual trial. The ATACH-II trial data, including de-identified participant data, are available indefinitely at the National Institute of Neurological Disorders and Stroke data archive (https://www.ninds.nih.gov/). To gain access, requesters will need to sign a data-access agreement.