Efficacy and safety of intensive blood pressure control for intracerebral hemorrhage: a Meta-analysis

Objective To evaluate the efficacy and safety of intensive blood pressure control for patients with intracerebral hemorrhage (ICH). Methods Retrieve relevant randomized controlled trials (RCTs) from online databases (January 1, 1980-September 30, 2015) as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: intracerebral hemorrhage, ICH, blood pressure, intensive, and acute. Selection of studies was performed according to pre-designed inclusion and exclusion criteria. Quality of studies was evaluated by using Jadad Scale. All data were pooled by RevMan 5.3 software for Meta-analysis. Results The research enrolled 3322 articles, from which 4 articles with Jadad score ≥ 4 were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 3360 ICH patients were included. Meta-nalysis showed intensive blood pressure control did not decrease the incidence of hematoma enlargement > 1/3 from baseline to 24 h ( RR = 0.910, 95%CI: 0.750-1.090; P = 0.310), neither associated with a favorable possibility on modified Rankin Scale (mRS) score ≤ 2 at 90 d of treatment ( RR = 1.070, 95% CI: 0.990-1.150; P = 0.090). Intensive blood pressure control did not increase National Institutes of Health Stroke Scale (NIHSS) score significantly ( RR = 0.950, 95%CI: 0.800-1.120; P = 0.530), nor increase the occurrence of adverse events in circulatory system ( RR = 0.910, 95%CI: 0.610-1.370; P = 0.660) or severe hypotension ( RR = 0.840, 95% CI: 0.370-1.940; P = 0.690). Conclusions Though intensive blood pressure control is unlikely to stop the enlargement of hematoma in a short term, it is likely to improve long-tem prognosis and reduce the rate of morbidity and mortality. Intensive blood pressure control is safe as it neither increase the symptoms of nervous system damage, nor the occurrence rate of circulatory system adverse events or severe hypotension. DOI: 10.3969/j.issn.1672-6731.2016.01.004