Early lowering of blood pressure after acute intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data
| Autor: | Craig S. Anderson, Hisatomi Arima, Sebastian Koch, Zhe Kang Law, Kenneth Butcher, Candice Delcourt, Leon Stephen Edwards, Nikola Sprigg, Wen Jiang, Jeffrey L. Saver, Joanna M. Wardlaw, Tom J Moullaali, Rustam Al-Shahi Salman, Xia Wang, Thompson G. Robinson, Adnan I Qureshi, Philip M.W. Bath, John F. Potter, Salil Gupta, Else Charlotte Sandset, John Chalmers, Lisa J Woodhouse |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty MEDLINE Blood Pressure Placebo Modified Rankin Scale Internal medicine Humans Medicine Stroke Antihypertensive Agents Aged Cerebral Hemorrhage Randomized Controlled Trials as Topic business.industry Guideline Middle Aged Random effects model medicine.disease stroke meta-analysis Psychiatry and Mental health Treatment Outcome Blood pressure Cerebrovascular Disease Meta-analysis Hypertension Female Surgery Neurology (clinical) business |
| Zdroj: | Moullaali, T J, Wang, X, Sandset, E C, Woodhouse, L J, Law, Z K, Arima, H, Butcher, K S, Chalmers, J, Delcourt, C, Edwards, L, Gupta, S, Jiang, W, Koch, S, Potter, J, Qureshi, A I, Robinson, T G, Al-shahi Salman, R, Saver, J L, Sprigg, N, Wardlaw, J M, Anderson, C S & Bath, P M 2021, ' Early lowering of blood pressure after acute intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data ', Journal of Neurology, Neurosurgery & Psychiatry, pp. jnnp-2021-327195 . https://doi.org/10.1136/jnnp-2021-327195 Journal of Neurology, Neurosurgery, and Psychiatry |
| ISSN: | 1468-330X 0022-3050 4201-9141 |
| Popis: | ObjectiveTo summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).MethodsA prespecified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents versus placebo or intensive versus guideline BP-lowering targets for adults 6 mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted using generalised linear mixed models with prespecified covariables and trial as a random effect.ResultsOf 7094 studies identified, 50 trials involving 11 494 patients were eligible and 16 (32.0%) shared patient-level data from 6221 (54.1%) patients (mean age 64.2 [SD 12.9], 2266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6–5.3). Active/intensive BP-lowering interventions had no effect on the primary outcome compared with placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95% CI 0.88 to 1.06; p=0.50), but there was significant heterogeneity by strategy (pinteraction=0.031) and agent (pinteraction6 ml, adjusted OR 0.75, 95%CI 0.60 to 0.92; p=0.0077) and relative (≥33%, adjusted OR 0.82, 95%CI 0.68 to 0.99; p=0.034) haematoma growth.InterpretationOverall, a broad range of interventions to lower BP within 7 days of ICH onset had no overall benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent.PROSPERO registration numberCRD42019141136. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|