Objective:

A systematic review and meta-analysis of randomized controlled trials (RCTs) was used to determine the efficacy of intensive blood pressure (iBP) control following spontaneous intraparenchymal hemorrhage (sIPH).  

Background:

To date, there has been no definitive data published regarding optimal blood pressure control following sIPH. This paper seeks to use available RCT data to determine the optimal blood pressure range.   

Design/Methods:

Databases for RCTs (up to 2023) involving management of blood pressure following sIPH were reviewed. Seven studies meet the inclusion/exclusion criteria and published data sufficient to calculate the effect of iBP lowering on post-stroke functional outcomes as measured by modified Rankin score (mRs), with scores being dichotomized as either poor (3-6) or good (0-2). Methods and definitions of intensive blood pressure treatments varied between studies; therefore, a random-effects meta-analysis model was used to evaluate the studies. 

Results:

Relative risk (RR) estimates ranged from a value of 0.87 (95% CI, 0.65-1.17) to a value of 1.27 (95% CI, 0.70-2.29). Five studies showed that iBP lowering was protective against poor functional outcome (RR < 1.00), one study found iBP lowering to be a risk factor for poor functional outcome (RR > 1.00), and one study estimated a RR of exactly 1.00. All but one study included the null value of 1.00 in the 95% confidence interval for their RR estimate. The summary RR effect for iBP lowering on post-stroke mRs functional outcome was 0.95 (95% CI, 0.92-0.98), which was statistically significant having a p < 0.01. Across all studies, the risk of poor mRs (3-6) post-stroke functional outcome was reduced by 5% for patients who received an intensive blood pressure lowering therapy.  

Conclusions:

A RR of 0.95 (95% CI, 0.92-0.98, p < 0.01) supports iBP lowering after sIPH and reduces the risk of poor functional outcome (mRs 3-6) when compared to standard blood pressure lowering.