Effectiveness and Safety of Intensive Blood Pressure Lowering for Intracerebral Hemorrhage: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 JIANGYu-shu ¹ , FENGYing ¹ ,  ZHANGJun-jian ²

1. Second Clinical College, Wuhan University, Wuhan 430071, China;
2. Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China;

Corresponding author：

ZHANGJun-jian, Email: xsssm@sina.cn

Keywords：

Intensive blood pressure lowering; Intracerebral hemorrhage; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20140161

Video：

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Objective To systematically review the effectiveness and safety of intensive blood pressure lowering in intracerebral hemorrhage (ICH). Methods Randomised controlled trials (RCTs) and quasi-RCTs about ICH patients receiving intensive blood pressure lowering were searched from PubMed, EMbase, SCIE, The Cochrane Library (Issue 2, 2013), CBM, CNKI, VIP and WanFang Data until March, 2014. Literature was screened according to the exclusion and inclusion criteria by two reviewers independently and meta-analysis was conducted using RevMan 5.2 software after data extraction and quality assessment. Results A total of 24 studies were included involving 6 299 patients, of which 10 were RCTs and 14 were quasi-RCTs. The results of meta-analysis showed that intensive blood pressure lowering was superior to guideline-recommended intervention in reducing 24-h hematoma expansion rates (OR=0.36, 95%CI 0.28 to 0.46, P < 0.05), 24-h hematoma expansion volume (MD=-3.71, 95%CI-4.15 to-3.28, P < 0.05) and perihematomal edema volume (MD=-1.09, 95%CI-1.92 to-0.22, P < 0.05). Meanwhile, intensive blood pressure lowering improved 21-d NIHSS score (MD=-3.44, 95%CI-5.02 to-1.87, P < 0.05). But there was no significant difference in mortality and adverse reaction between the two groups. Conclusion Current evidence shows that intensive blood pressure lowering could reduce hematoma expansion volume and perihematomal edema volume, which is beneficial to recovery of neurological function, but ICH patients' long-term prognosis needs to be further studied. Due to the limited quantity and quality of the included studies, high quality studies are needed to verify the above conclusion.

Citation： JIANGYu-shu, FENGYing, ZHANGJun-jian. Effectiveness and Safety of Intensive Blood Pressure Lowering for Intracerebral Hemorrhage: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 974-983. doi: 10.7507/1672-2531.20140161 Copy

1.	Qureshi AI, Tuhrim S, Broderick JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med, 2001, 344(19): 1450-1460.
2.	Flaherty ML, Haverbusch M, Sekar P, et al. Long-term mortality after intracerebral hemorrhage. Neurology, 2006, 66(8): 1182-1186.
3.	Davis S, Hennerici M, Brun N, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology, 2006, 66(8): 1175-1181.
4.	Broderick J, Diringer M, Hill M, et al. Determinants of intracerebral hemorrhage growth: an exploratory analysis. Stroke, 2007, 38(3): 1072-1075.
5.	陈新, 周中和.高血压性脑出血早期强化降血压是否有益.中国实用内科杂志, 2008, 28(10): 902-904.
6.	谭燕, 刘鸣.脑卒中急性期血压变化与预后关系及对血压处理的研究进展.临床神经病学杂志, 2005, 18(4): 313-314.
7.	International Society of Hypertension Writing Group. International Society of Hypertension: statement on the management of blood pressurein acute stroke. J Hypertens, 2003, 21(4): 665-672.
8.	Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke, 2007, 38(6): 2001-2023.
9.	饶明俐, 主编.中国脑血管病防治指南.第1版.北京:人民卫生出版社, 2007: 35-40.
10.	Okumura K, Ohya Y, Maehara A, et al. Effects of blood pressure levels on case fatality after acute stroke. J Hypertens, 2005, 23: 1217-1223.
11.	Terayama Y, Tanahashi N, Fukuuchi Y, et al. Prognostic value of admission blood pressure in patients with intracerebral hemorrhage: Keio Cooperative Stroke Study. Stroke, 1997, 28(6): 1185-1188.
12.	Qureshi AI, Mohammad YM, Yahia AM, et al. A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage. J Intensive Care Med, 2005, 20(1): 34-42.
13.	Anderson CS, Huang YN, Wang JG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial(INTERACT):a randomised pilot trial. Lancet Neurol, 2008, 7(5): 391-399.
14.	Mayer SA, BrunNC, Begtrup K, et al. Efficacy and safety of recombinant activated factor Ⅶ for acute intracerebral hemorrhage. N Engl J Med, 2008, 358(20): 2127-2137.
15.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
16.	刘鸣, 主编.系统评价、Meta-分析设计与实施方法.第1版.北京:人民卫生出版社, 2011: 100.
17.	Anderson CS, Huang Y, Arima H, et al. Effects of Early Intensive Blood Pressure-Lowering Treatment on the Growth of Hematoma and Perihematomal Edema in Acute Intracerebral Hemorrhage: The Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke, 2010, 41(2): 307-312.
18.	Koch S, Romano JG, Forteza AM, et al. Rapid Blood Pressure Reduction in Acute Intracerebral Hemorrhage: Feasibility and Safety. Neurocrit Care, 2008, 8(3): 316-321.
19.	Anderson CS, Heeley E, Huang Y, et al. Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage. N Engl J Med, 2013, 368(25): 2355-2365.
20.	段光霞.高血压脑出血早期降压对血肿扩大的影响.中国实用医药, 2011, 6(34): 95-96.
21.	宋维根, 钟建国, 肖佩荣, 等.高血压脑出血患者早期强化降压对血肿扩大的影响.临床神经病学杂志, 2010, 23(1): 58-60.
22.	李建甫.高血压脑出血患者早期降压对血肿扩大的影响.中国实用医药, 2011, 6(9): 114-115.
23.	李元斌, 邓发斌, 陈淳, 等.微泵输注丙泊酚和硝普钠在脑出血急性期的镇静强化降压的疗效观察.安徽医药, 2013, 17(3): 495-497.
24.	罗紫英, 鞠德仁.早期强化降压治疗脑出血的疗效观察.实用临床医学, 2010, 11(9): 10-12.
25.	马世江, 赵家鹏, 李静, 等.早期强化降压对高血压脑出血血肿扩大的治疗作用.中国实用神经疾病杂志, 2013, 16(7): 19-21.
26.	孙自伟.高血压脑出血早期降压对血肿扩大的影响.中国实用神经疾病杂志, 2012, 15(3): 55-56.
27.	王希瑞.早期降压治疗对高血压脑出血患者血肿扩大的影响.中国实用医药, 2012, 7(27): 118-119.
28.	李玲, 张锦丽, 宋扬.早期降压对高血压性脑出血患者近期疗效影响.现代中西医结合杂志. 2011, 20(22): 2787-2788.
29.	张海欣, 顾芳, 黄英俊, 等.早期强化降压治疗脑出血对血肿周围水肿的影响观察.疑难病杂志, 2011, 10(12): 894-896.
30.	陈皆春, 孙德锦, 葛中林, 等.乌拉地尔强化降压治疗对高血压性脑出血患者血肿扩大的影响.临床神经病学杂志, 2010, 23(6): 420-422.
31.	张士杰, 冯国栋, 冯晓丽.早期强化降压对高血压脑出血患者血肿扩大的影响.中国煤炭工业医学杂志, 2011, 14(7): 1002-1003.
32.	巩法桃, 于立萍, 李霞, 等.控制血压对超早期基底节区脑出血血肿扩大和神经功能的影响.中国综合临床, 2013, 29(4): 360-363.
33.	冼明健, 雷建明, 袁莉, 等.急性脑出血患者早期强化降血压治疗的疗效及安全性研究.医药论坛杂志, 2010, 31(1): 20-22.
34.	徐波, 张铭, 赵惊, 等.急性期血压控制与血肿扩大关系的对照研究.神经损伤与功能重建, 2010, 5(5): 386-387.
35.	赵艳云.降压对脑出血早期血肿扩大的影响分析.中国社区医师:医学专业, 2012, 14(26): 63.
36.	瞿启飞, 黄进.高血压脑出血124例早期积极降压对控制血肿扩大及预后影响.交通医学, 2012, 26(5): 457-458.
37.	江明庆.高血压脑出血后强化降压对预后的影响.中国现代应用药学, 2013, 30(7): 785-788.
38.	姜爱钟, 张建明, 杨光绪.高血压脑出血早期降压对血肿扩大的影响.医学综述, 2013, 19(23): 4369-4370.
39.	梁士宇.高血压性脑出血患者早期降压治疗对短期预后影响的研究.现代中西医结合杂志, 2013, 22(16): 1775-1778.
40.	栾璟煜, 王伊龙.血肿扩大是ICH后死亡和预后不良的决定性因素.中国卒中杂志, 2006, 1(5): 360.
41.	Qureshi AI, Ezzeddine MA, Nasar A, et al. Prevalence of elevated blood pressure in 563, 704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med, 2007, 25(1): 32-38.
42.	Powers WJ. Autoregulation of cerebral blood flow surrounding acute (2 to 22 hours) intracerebral hemorrhage. Neurology, 2001, 57(1): 18-24．.
43.	Qureshi AI, Tariq N, Divani AA, et al. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med, 2010, 38(2): 637-648.
44.	Morgenstern LB, Hemphill JC 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2010, 41(9): 2108-2129.

1. Qureshi AI, Tuhrim S, Broderick JP, et al. Spontaneous intracerebral hemorrhage. N Engl J Med, 2001, 344(19): 1450-1460.
2. Flaherty ML, Haverbusch M, Sekar P, et al. Long-term mortality after intracerebral hemorrhage. Neurology, 2006, 66(8): 1182-1186.
3. Davis S, Hennerici M, Brun N, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology, 2006, 66(8): 1175-1181.
4. Broderick J, Diringer M, Hill M, et al. Determinants of intracerebral hemorrhage growth: an exploratory analysis. Stroke, 2007, 38(3): 1072-1075.
5. 陈新, 周中和.高血压性脑出血早期强化降血压是否有益.中国实用内科杂志, 2008, 28(10): 902-904.
6. 谭燕, 刘鸣.脑卒中急性期血压变化与预后关系及对血压处理的研究进展.临床神经病学杂志, 2005, 18(4): 313-314.
7. International Society of Hypertension Writing Group. International Society of Hypertension: statement on the management of blood pressurein acute stroke. J Hypertens, 2003, 21(4): 665-672.
8. Broderick J, Connolly S, Feldmann E, et al. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke, 2007, 38(6): 2001-2023.
9. 饶明俐, 主编.中国脑血管病防治指南.第1版.北京:人民卫生出版社, 2007: 35-40.
10. Okumura K, Ohya Y, Maehara A, et al. Effects of blood pressure levels on case fatality after acute stroke. J Hypertens, 2005, 23: 1217-1223.
11. Terayama Y, Tanahashi N, Fukuuchi Y, et al. Prognostic value of admission blood pressure in patients with intracerebral hemorrhage: Keio Cooperative Stroke Study. Stroke, 1997, 28(6): 1185-1188.
12. Qureshi AI, Mohammad YM, Yahia AM, et al. A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage. J Intensive Care Med, 2005, 20(1): 34-42.
13. Anderson CS, Huang YN, Wang JG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial(INTERACT):a randomised pilot trial. Lancet Neurol, 2008, 7(5): 391-399.
14. Mayer SA, BrunNC, Begtrup K, et al. Efficacy and safety of recombinant activated factor Ⅶ for acute intracerebral hemorrhage. N Engl J Med, 2008, 358(20): 2127-2137.
15. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: www.cochrane-handbook.org.
16. 刘鸣, 主编.系统评价、Meta-分析设计与实施方法.第1版.北京:人民卫生出版社, 2011: 100.
17. Anderson CS, Huang Y, Arima H, et al. Effects of Early Intensive Blood Pressure-Lowering Treatment on the Growth of Hematoma and Perihematomal Edema in Acute Intracerebral Hemorrhage: The Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke, 2010, 41(2): 307-312.
18. Koch S, Romano JG, Forteza AM, et al. Rapid Blood Pressure Reduction in Acute Intracerebral Hemorrhage: Feasibility and Safety. Neurocrit Care, 2008, 8(3): 316-321.
19. Anderson CS, Heeley E, Huang Y, et al. Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage. N Engl J Med, 2013, 368(25): 2355-2365.
20. 段光霞.高血压脑出血早期降压对血肿扩大的影响.中国实用医药, 2011, 6(34): 95-96.
21. 宋维根, 钟建国, 肖佩荣, 等.高血压脑出血患者早期强化降压对血肿扩大的影响.临床神经病学杂志, 2010, 23(1): 58-60.
22. 李建甫.高血压脑出血患者早期降压对血肿扩大的影响.中国实用医药, 2011, 6(9): 114-115.
23. 李元斌, 邓发斌, 陈淳, 等.微泵输注丙泊酚和硝普钠在脑出血急性期的镇静强化降压的疗效观察.安徽医药, 2013, 17(3): 495-497.
24. 罗紫英, 鞠德仁.早期强化降压治疗脑出血的疗效观察.实用临床医学, 2010, 11(9): 10-12.
25. 马世江, 赵家鹏, 李静, 等.早期强化降压对高血压脑出血血肿扩大的治疗作用.中国实用神经疾病杂志, 2013, 16(7): 19-21.
26. 孙自伟.高血压脑出血早期降压对血肿扩大的影响.中国实用神经疾病杂志, 2012, 15(3): 55-56.
27. 王希瑞.早期降压治疗对高血压脑出血患者血肿扩大的影响.中国实用医药, 2012, 7(27): 118-119.
28. 李玲, 张锦丽, 宋扬.早期降压对高血压性脑出血患者近期疗效影响.现代中西医结合杂志. 2011, 20(22): 2787-2788.
29. 张海欣, 顾芳, 黄英俊, 等.早期强化降压治疗脑出血对血肿周围水肿的影响观察.疑难病杂志, 2011, 10(12): 894-896.
30. 陈皆春, 孙德锦, 葛中林, 等.乌拉地尔强化降压治疗对高血压性脑出血患者血肿扩大的影响.临床神经病学杂志, 2010, 23(6): 420-422.
31. 张士杰, 冯国栋, 冯晓丽.早期强化降压对高血压脑出血患者血肿扩大的影响.中国煤炭工业医学杂志, 2011, 14(7): 1002-1003.
32. 巩法桃, 于立萍, 李霞, 等.控制血压对超早期基底节区脑出血血肿扩大和神经功能的影响.中国综合临床, 2013, 29(4): 360-363.
33. 冼明健, 雷建明, 袁莉, 等.急性脑出血患者早期强化降血压治疗的疗效及安全性研究.医药论坛杂志, 2010, 31(1): 20-22.
34. 徐波, 张铭, 赵惊, 等.急性期血压控制与血肿扩大关系的对照研究.神经损伤与功能重建, 2010, 5(5): 386-387.
35. 赵艳云.降压对脑出血早期血肿扩大的影响分析.中国社区医师:医学专业, 2012, 14(26): 63.
36. 瞿启飞, 黄进.高血压脑出血124例早期积极降压对控制血肿扩大及预后影响.交通医学, 2012, 26(5): 457-458.
37. 江明庆.高血压脑出血后强化降压对预后的影响.中国现代应用药学, 2013, 30(7): 785-788.
38. 姜爱钟, 张建明, 杨光绪.高血压脑出血早期降压对血肿扩大的影响.医学综述, 2013, 19(23): 4369-4370.
39. 梁士宇.高血压性脑出血患者早期降压治疗对短期预后影响的研究.现代中西医结合杂志, 2013, 22(16): 1775-1778.
40. 栾璟煜, 王伊龙.血肿扩大是ICH后死亡和预后不良的决定性因素.中国卒中杂志, 2006, 1(5): 360.
41. Qureshi AI, Ezzeddine MA, Nasar A, et al. Prevalence of elevated blood pressure in 563, 704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med, 2007, 25(1): 32-38.
42. Powers WJ. Autoregulation of cerebral blood flow surrounding acute (2 to 22 hours) intracerebral hemorrhage. Neurology, 2001, 57(1): 18-24．.
43. Qureshi AI, Tariq N, Divani AA, et al. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med, 2010, 38(2): 637-648.
44. Morgenstern LB, Hemphill JC 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2010, 41(9): 2108-2129.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Intensive Blood Pressure Lowering for Intracerebral Hemorrhage: A Systematic Review

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