Abstract Details

Title Efficacy of Intensive Blood Pressure Lowering on Outcomes in Spontaneous Intraparenchymal Hemorrhage: A Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-007

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.

Authors/Disclosures
Kenneth B. Jordan, MD, PhD (Loyola University Medical Center) PRESENTER	Mr. Jordan has nothing to disclose.
Mohammad A. Azeem, MD	Dr. Azeem has nothing to disclose.
Jonna Peterson	Ms. Peterson has nothing to disclose.
Michael Wesolowski, MPH	Mr. Wesolowski has nothing to disclose.
Michael J. Schneck, MD, FAAN (Loyola University Chicago, Stritch School of Medicine)	An immediate family member of Dr. Schneck has received personal compensation for serving as an employee of Cellcarta. Dr. Schneck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for HLT Medical. Dr. Schneck has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Miscellaneous legal firms. Dr. Schneck has stock in Baxter Labs. The institution of Dr. Schneck has received research support from NIH.

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