TY - JOUR
T1 - Early lowering of blood pressure after acute intracerebral haemorrhage: A systematic review and meta-analysis of individual patient data
AU - Moullaali, Tom J.
AU - Wang, Xia
AU - Sandset, Else Charlotte
AU - Woodhouse, Lisa J.
AU - Law, Zhe Kang
AU - Arima, Hisatomi
AU - Butcher, Kenneth S.
AU - Chalmers, John
AU - Delcourt, Candice
AU - Edwards, Leon
AU - Gupta, Salil
AU - Jiang, Wen
AU - Koch, Sebastian
AU - Potter, John
AU - Qureshi, Adnan I.
AU - Robinson, Thompson G.
AU - Al-Shahi Salman, Rustam
AU - Saver, Jeffrey L.
AU - Sprigg, Nikola
AU - Wardlaw, Joanna M.
AU - Anderson, Craig S.
AU - Bath, Philip M.
AU - On behalf of the Blood Pressure in Acute Stroke (BASC) Investigators
N1 - Data availability statement: 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.
PY - 2022/1
Y1 - 2022/1
N2 - 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 (p
interaction=0.031) and agent (p
interaction <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.
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 (p
interaction=0.031) and agent (p
interaction <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.
KW - meta-analysis
KW - stroke
UR - https://www.scopus.com/pages/publications/85122772171
U2 - 10.1136/jnnp-2021-327195
DO - 10.1136/jnnp-2021-327195
M3 - Article
SN - 0022-3050
VL - 93
SP - 6
EP - 13
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
IS - 1
ER -