title: How Should We Lower Blood Pressure after Cerebral Hemorrhage? A Systematic Review and Meta-Analysis.
abstract: The optimal treatment of high blood pressure (BP) after acute intra-cerebral hemorrhage (ICH) is controversial.
  
  
  
  The aim of the study was to evaluate the safety and efficacy of early intensive vs. conservative BP lowering treatment in patients with ICH. Randomized controlled trials with active and control groups receiving intensive and conservative BP lowering treatments were identified. The following outcomes were assessed: 3-month mortality and combined death or major disability, 24-h hematoma growth, early neurological deterioration, occurrence of hypotension, severe hypotension, and serious treatment-emergent adverse events. Five trials were included involving 4,350 participants, 2,162 and 2,188 for intensive and conservative treatment groups, respectively. The pooled risk ratio of 3-month death or major disability was 0.96 (0.91-1.01) and the weighted mean difference in absolute hematoma growth was -1.53 (95% CI -2.94 to -0.12) mL in the intensive compared to conservative BP-lowering. There were no differences across the treatments in the incidence rates of 3-month mortality, early neurological deterioration, hypotension, and treatment-related adverse effects other than renal events. Key Messages: The early intensive anti-hypertensive treatment was overall safe and reduced the hematoma expansion in patients presenting with acute-onset spontaneous ICH and high BP levels.
authors.affiliation: Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Lattanzi
authors.forename: Claudia
authors.initials: C
authors.lastname: Cagnetti
authors.forename: Leandro
authors.initials: L
authors.lastname: Provinciali
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: Acute stroke; Blood pressure; Cerebrovascular disease; Intracerebral hemorrhage