Aggressive Blood Pressure Lowing Therapy in Patients with Acute Intracerebral Hemorrhage is Safe: A Systematic Review and Meta-analysis
- Author:
- No author available
- Journal Title:
- Chinese Medical Journal
- Issue:
- 18
- DOI:
- 10.4103/0366-6999.164982
- Key Word:
- Antihypertensive Therapy;Blood Pressure;Hematoma Enlargement;Hypertension;Intracerebral Hemorrhage
Abstract： Background:The influence of blood pressure (BP) lowering on intracerebral hemorrhage (ICH) patients is unclear.To assess the safety and efficacy of aggressive antihypertensive therapies in acute ICH patients,we carried out a systematic review and meta-analysis.Methods:PubMed,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and VIP database up to July 2014 were searched.High-quality randomized controlled trials were included.Low-quality trials were excluded.Serious adverse events were defined as the primary outcome.The secondary outcomes were hematoma enlargement (HE) at 24 h after onset,mortality,and favorable clinical outcome at 90 days.Results:Four high-quality trials involving a total of 1427 patients met the inclusion criteria and were analyzed.Odds ratios (ORs) of primary outcome was 0.96 (95％ confidence interval [CI]:0.82-1.13,P =0.61).ORs of HE at 24 h after onset,mortality and favorable clinical outcome at 90 days were 0.91 (95％ CI:0.72-1.17,P =0.47),0.97 (95％ CI:0.79-1.20,P =0.81),1.13 (95％ CI:0.98-1.30,P =0.09) respectively.Conclusions:Aggressive BP management policies are safe and might have a potency of reducing HE and improving clinical outcome.
- [1]Li YC,Morgenstern LB,Wang JG,etc.Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial.[J].2008,7(5).
- [2]Balami JS,Buchan AM.Complications of intracerebral haemorrhage.[J].2012,11(1).
- [3]Hill MD,Mayer SA,Brun NC,etc.Determinants of intracerebral hemorrhage growth: an exploratory analysis.[J].2007,38(3).
- [4]Broderick J. P.,Brott T. G.,Duldner J. E.,etc.Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality[J].1993.
- [5]Rodriguez Luna D,Rubiera M,Ribo M,etc.Ultraearly hematoma growth predicts poor outcome after acute intracerebral hemorrhage.[J].2011,77(17).
- [6]Koch S,Otero CM,Forteza AM,etc.Rapid blood pressure reduction in acute intracerebral hemorrhage: feasibility and safety.[J].2008,8(3).
- [7]Davis S,Diringer MN,Brun NC,etc.Recombinant activated factor VII for acute intracerebral hemorrhage.[J].2005,352(8).
- [8]Martin R,Goldstein JN,Palesch YY,etc.Effect of systolic blood pressure reduction on hematoma expansion, perihematomal edema, and 3-month outcome among patients with intracerebral hemorrhage: results from the antihypertensive treatment of acute cerebral hemorrhage study.[J].2010,67(5).
- [9]Martinez-Ramirez S,Martinez-Corral M,Suarez-Calvet M,etc.Blood pressure is not associated with haematoma enlargement in acute intracerebral haemorrhage.[J].2008,15(10).
- [10]Inoue T,Kobayashi K,Matsumoto N,etc.Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage.[J].2007,255(1).
- [11]Kazui S.,Minematsu K.,Yamamoto H.,etc.Predisposing Factors to Enlargement of Spontaneous Intracerebral Hematoma[J].1997.
- [12]Emma Heeley,Jiguang Wang,Craig S. Anderson,etc.Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage[J].2013,368(25).
- [13]Ohwaki K,Nagashima H,Hirata M,etc.Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement.[J].2004,35(6).
- [14]Lewis B, Morgenstern,J Claude, Hemphill,Craig, Anderson,etc.Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.[J].2010,41.
- [15]Broderick J,Davis SM,Begtrup K,etc.Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage.[J].2006,66(8).
- [16]J Max Findlay,Thomas Jeerakathil,Ashfaq Shuaib,etc.The intracerebral hemorrhage acutely decreasing arterial pressure trial.[J].2013,44(3).
- [17]Lisa Manning,Yoichiro Hirakawa,Hisatomi Arima,etc.Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial.[J].2014,13(4).
- [18]Mayer SA,Wartenberg KE.Reducing the risk of ICH enlargement.[J].2007,261(1).
- [19]Herweh C,Schellinger PD,Schramm P,etc.Evidence against a perihemorrhagic penumbra provided by perfusion computed tomography.[J].2007,38(11).
- [20]John Chalmers,Candice Delcourt,Yining Huang,etc.Hematoma growth and outcomes in intracerebral hemorrhage: The INTERACT1 study.[J].2012,79(4).
- [21]Mendelow AD,Qureshi AI,Hanley DF.Intracerebral haemorrhage.[J].2009,373(9675).
- [22]Tanaka R,Takeuchi S,Fujii Y ri.niigata-u.ac.jp,etc.Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage.[J].1998,29(6).