Intensive Blood Pressure Lowering Provides No Mortality Benefit in Acute Intracerebral Hemorrhage

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The investigators noted that some variability existed in blood pressure targets and patient demographics among included studies.
The investigators noted that some variability existed in blood pressure targets and patient demographics among included studies.

Intensive blood pressure lowering with a goal systolic blood pressure <140 mm Hg provides no significant effect for improving functional outcome or reducing mortality among patients with acute intracerebral hemorrhage (ICH) when compared with standard blood pressure control of <180 mm Hg, according to findings from a meta-analysis published in the Annals of Emergency Medicine.

In this meta-analysis, investigators reviewed and included 5 randomized controlled trials that reported functional outcomes and mortality rates among patients with ICH following intensive blood pressure lowering (n=4360). The 3-month mortality rate and significant disability (modified Rankin Scale score >3) comprised the primary outcome.

Intensive blood pressure lowering did not result in significant decreases in 3-month mortality (odds ratio [OR] 0.99; 95% CI, 0.82-1.20) or 3-month death or dependency (OR 0.91; 95% CI, 0.81-1.03) when compared with standard blood pressure control. Additionally, there was no clinical benefit for decreasing the rates of significant disability (OR 0.92; 95% CI, 0.69-1.23) or hemorrhage expansion (OR 0.82; 95% CI, 0.68-1.00), according to the pooled analysis.

Although the statistical heterogeneity for the primary outcomes was 0%, the investigators note that some variability existed in blood pressure targets and patient demographics among included studies. In addition, more than half of the patient data were taken from the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage (INTERACT2) trial, thereby limiting the findings to this specific population group.

Considering no benefit was found for lowering blood pressure to <140 mm Hg in patients with acute ICH, emergency clinicians may consider continuing the management of “patients with ICH in accordance with the American Heart Association/American Stroke Association guidelines, which recommend reducing systolic blood pressure to 140 mm Hg.”

Reference

Brodrick ZT, Freeze-Ramsey R, Seupaul RA. Among patients with intracerebral hemorrhage, is intensive blood pressure decreasing associated with improved outcome? [published online February 15, 2018]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.01.018

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