title: Intensive blood pressure reduction in acute intracerebral hemorrhage: a meta-analysis.
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 ± 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 = 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 = 0.87, 95% confidence interval: 0.76-1.01; p = 0.062). No evidence of heterogeneity between estimates (I(2) = 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.
authors.affiliation: From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece. tsivgoulisgiorg@yahoo.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.affiliation: From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece.
authors.forename: Aristeidis H
authors.initials: AH
authors.lastname: Katsanos
authors.affiliation: From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Butcher
authors.affiliation: From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece.
authors.forename: Efstathios
authors.initials: E
authors.lastname: Boviatsis
authors.affiliation: From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece.
authors.forename: Nikos
authors.initials: N
authors.lastname: Triantafyllou
authors.affiliation: From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Rizos
authors.affiliation: From the Second Department of Neurology (G.T.), Second Department of Neurosurgery (E.B.), and Second Department of Cardiology (I.R.), Attikon Hospital, School of Medicine, University of Athens, Greece; Department of Neurology (G.T., A.V.A.), The University of Tennessee Health Science Center, Memphis; International Clinical Research Center (G.T.), Department of Neurology, St. Anne's University Hospital in Brno, Czech Republic; Department of Neurology (A.H.K.), School of Medicine, University of Ioannina, Greece; Division of Neurology (K.S.B.), University of Alberta, Edmonton, Canada; and First Department of Neurology (N.T.), Eginition Hospital, School of Medicine, University of Athens, Greece.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000188:drug therapy* / Q000209:etiology; D016239:MEDLINE / Q000706:statistics & numerical data; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data
chemical_list: D000959:Antihypertensive Agents