Intensive blood pressure reduction in acute intracerebral hemorrhage

A meta-analysis

Georgios Tsivgoulis, Aristeidis H. Katsanos, Kenneth S. Butcher, Efstathios Boviatsis, Nikos Triantafyllou, Ioannis Rizos, Andrei Alexandrov

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Objective: The aim of the present systematic review and meta-analysis was to evaluate the safety and efficacy of intensive blood pressure (BP) reduction in patients with acute-onset intracerebral hemorrhage (ICH) using data from randomized controlled trials. Methods: We conducted a systematic review and meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines of all available randomized controlled trials that randomized patients with acute ICH to either intensive or guideline BP-reduction protocols. Results: We identified 4 eligible studies, including a total of 3,315 patients (mean age 63.4 6 1.4 years, 64% men). Death rates were similar between patients randomized to intensive BP-lowering treatment and those receiving guideline BP-lowering treatment (odds ratio 5 1.01, 95% confidence interval: 0.83-1.23; p = 0.914). Intensive BP-lowering treatment tended to be associated with lower 3-month death or dependency (modified Rankin Scale grades 3-6) compared with guideline treatment (odds ratio 5 0.87, 95% confidence interval: 0.76-1.01; p = 0.062). No evidence of heterogeneity between estimates (I2 5 0%; p = 0.723), or publication bias in the funnel plots (p = 0.993, Egger statistical test), was detected. Intensive BP reduction was also associated with a greater attenuation of absolute hematoma growth at 24 hours (standardized mean difference ± SE: -0.110 ± 0.053; p = 0.038). Conclusions: Our findings indicate that intensive BP management in patients with acute ICH is safe. Fewer intensively treated patients had unfavorable 3-month functional outcome although this finding did not reach significance. Moreover, intensive BP reduction appears to be associated with a greater attenuation of absolute hematoma growth at 24 hours.

Original languageEnglish (US)
Pages (from-to)1523-1529
Number of pages7
JournalNeurology
Volume83
Issue number17
DOIs
StatePublished - Jan 1 2014

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Cerebral Hemorrhage
Meta-Analysis
Blood Pressure
Guidelines
Hematoma
Randomized Controlled Trials
Odds Ratio
Confidence Intervals
Publication Bias
Therapeutics
Growth
Safety
Mortality

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

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Intensive blood pressure reduction in acute intracerebral hemorrhage : A meta-analysis. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Butcher, Kenneth S.; Boviatsis, Efstathios; Triantafyllou, Nikos; Rizos, Ioannis; Alexandrov, Andrei.

In: Neurology, Vol. 83, No. 17, 01.01.2014, p. 1523-1529.

Research output: Contribution to journalArticle

Tsivgoulis, G, Katsanos, AH, Butcher, KS, Boviatsis, E, Triantafyllou, N, Rizos, I & Alexandrov, A 2014, 'Intensive blood pressure reduction in acute intracerebral hemorrhage: A meta-analysis', Neurology, vol. 83, no. 17, pp. 1523-1529. https://doi.org/10.1212/WNL.0000000000000917
Tsivgoulis G, Katsanos AH, Butcher KS, Boviatsis E, Triantafyllou N, Rizos I et al. Intensive blood pressure reduction in acute intracerebral hemorrhage: A meta-analysis. Neurology. 2014 Jan 1;83(17):1523-1529. https://doi.org/10.1212/WNL.0000000000000917
Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Butcher, Kenneth S. ; Boviatsis, Efstathios ; Triantafyllou, Nikos ; Rizos, Ioannis ; Alexandrov, Andrei. / Intensive blood pressure reduction in acute intracerebral hemorrhage : A meta-analysis. In: Neurology. 2014 ; Vol. 83, No. 17. pp. 1523-1529.
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