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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Abstract Full text Figures/Tables Video References Cited by

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.	陳新, 周中和.高血壓性腦出血早期強化降血壓是否有益.中國實用內科雜志, 2008, 28(10): 902-904.
6.	譚燕, 劉鳴.腦卒中急性期血壓變化與預后關系及對血壓處理的研究進展.臨床神經病學雜志, 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.	饒明俐, 主編.中國腦血管病防治指南.第1版.北京:人民衛生出版社, 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.	劉鳴, 主編.系統評價、Meta-分析設計與實施方法.第1版.北京:人民衛生出版社, 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.高血壓腦出血早期降壓對血腫擴大的影響.中國實用醫藥, 2011, 6(34): 95-96.
21.	宋維根, 鐘建國, 肖佩榮, 等.高血壓腦出血患者早期強化降壓對血腫擴大的影響.臨床神經病學雜志, 2010, 23(1): 58-60.
22.	李建甫.高血壓腦出血患者早期降壓對血腫擴大的影響.中國實用醫藥, 2011, 6(9): 114-115.
23.	李元斌, 鄧發斌, 陳淳, 等.微泵輸注丙泊酚和硝普鈉在腦出血急性期的鎮靜強化降壓的療效觀察.安徽醫藥, 2013, 17(3): 495-497.
24.	羅紫英, 鞠德仁.早期強化降壓治療腦出血的療效觀察.實用臨床醫學, 2010, 11(9): 10-12.
25.	馬世江, 趙家鵬, 李靜, 等.早期強化降壓對高血壓腦出血血腫擴大的治療作用.中國實用神經疾病雜志, 2013, 16(7): 19-21.
26.	孫自偉.高血壓腦出血早期降壓對血腫擴大的影響.中國實用神經疾病雜志, 2012, 15(3): 55-56.
27.	王希瑞.早期降壓治療對高血壓腦出血患者血腫擴大的影響.中國實用醫藥, 2012, 7(27): 118-119.
28.	李玲, 張錦麗, 宋揚.早期降壓對高血壓性腦出血患者近期療效影響.現代中西醫結合雜志. 2011, 20(22): 2787-2788.
29.	張海欣, 顧芳, 黃英俊, 等.早期強化降壓治療腦出血對血腫周圍水腫的影響觀察.疑難病雜志, 2011, 10(12): 894-896.
30.	陳皆春, 孫德錦, 葛中林, 等.烏拉地爾強化降壓治療對高血壓性腦出血患者血腫擴大的影響.臨床神經病學雜志, 2010, 23(6): 420-422.
31.	張士杰, 馮國棟, 馮曉麗.早期強化降壓對高血壓腦出血患者血腫擴大的影響.中國煤炭工業醫學雜志, 2011, 14(7): 1002-1003.
32.	鞏法桃, 于立萍, 李霞, 等.控制血壓對超早期基底節區腦出血血腫擴大和神經功能的影響.中國綜合臨床, 2013, 29(4): 360-363.
33.	冼明健, 雷建明, 袁莉, 等.急性腦出血患者早期強化降血壓治療的療效及安全性研究.醫藥論壇雜志, 2010, 31(1): 20-22.
34.	徐波, 張銘, 趙驚, 等.急性期血壓控制與血腫擴大關系的對照研究.神經損傷與功能重建, 2010, 5(5): 386-387.
35.	趙艷云.降壓對腦出血早期血腫擴大的影響分析.中國社區醫師:醫學專業, 2012, 14(26): 63.
36.	瞿啟飛, 黃進.高血壓腦出血124例早期積極降壓對控制血腫擴大及預后影響.交通醫學, 2012, 26(5): 457-458.
37.	江明慶.高血壓腦出血后強化降壓對預后的影響.中國現代應用藥學, 2013, 30(7): 785-788.
38.	姜愛鐘, 張建明, 楊光緒.高血壓腦出血早期降壓對血腫擴大的影響.醫學綜述, 2013, 19(23): 4369-4370.
39.	梁士宇.高血壓性腦出血患者早期降壓治療對短期預后影響的研究.現代中西醫結合雜志, 2013, 22(16): 1775-1778.
40.	欒璟煜, 王伊龍.血腫擴大是ICH后死亡和預后不良的決定性因素.中國卒中雜志, 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. 陳新, 周中和.高血壓性腦出血早期強化降血壓是否有益.中國實用內科雜志, 2008, 28(10): 902-904.
6. 譚燕, 劉鳴.腦卒中急性期血壓變化與預后關系及對血壓處理的研究進展.臨床神經病學雜志, 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. 饒明俐, 主編.中國腦血管病防治指南.第1版.北京:人民衛生出版社, 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. 劉鳴, 主編.系統評價、Meta-分析設計與實施方法.第1版.北京:人民衛生出版社, 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.高血壓腦出血早期降壓對血腫擴大的影響.中國實用醫藥, 2011, 6(34): 95-96.
21. 宋維根, 鐘建國, 肖佩榮, 等.高血壓腦出血患者早期強化降壓對血腫擴大的影響.臨床神經病學雜志, 2010, 23(1): 58-60.
22. 李建甫.高血壓腦出血患者早期降壓對血腫擴大的影響.中國實用醫藥, 2011, 6(9): 114-115.
23. 李元斌, 鄧發斌, 陳淳, 等.微泵輸注丙泊酚和硝普鈉在腦出血急性期的鎮靜強化降壓的療效觀察.安徽醫藥, 2013, 17(3): 495-497.
24. 羅紫英, 鞠德仁.早期強化降壓治療腦出血的療效觀察.實用臨床醫學, 2010, 11(9): 10-12.
25. 馬世江, 趙家鵬, 李靜, 等.早期強化降壓對高血壓腦出血血腫擴大的治療作用.中國實用神經疾病雜志, 2013, 16(7): 19-21.
26. 孫自偉.高血壓腦出血早期降壓對血腫擴大的影響.中國實用神經疾病雜志, 2012, 15(3): 55-56.
27. 王希瑞.早期降壓治療對高血壓腦出血患者血腫擴大的影響.中國實用醫藥, 2012, 7(27): 118-119.
28. 李玲, 張錦麗, 宋揚.早期降壓對高血壓性腦出血患者近期療效影響.現代中西醫結合雜志. 2011, 20(22): 2787-2788.
29. 張海欣, 顧芳, 黃英俊, 等.早期強化降壓治療腦出血對血腫周圍水腫的影響觀察.疑難病雜志, 2011, 10(12): 894-896.
30. 陳皆春, 孫德錦, 葛中林, 等.烏拉地爾強化降壓治療對高血壓性腦出血患者血腫擴大的影響.臨床神經病學雜志, 2010, 23(6): 420-422.
31. 張士杰, 馮國棟, 馮曉麗.早期強化降壓對高血壓腦出血患者血腫擴大的影響.中國煤炭工業醫學雜志, 2011, 14(7): 1002-1003.
32. 鞏法桃, 于立萍, 李霞, 等.控制血壓對超早期基底節區腦出血血腫擴大和神經功能的影響.中國綜合臨床, 2013, 29(4): 360-363.
33. 冼明健, 雷建明, 袁莉, 等.急性腦出血患者早期強化降血壓治療的療效及安全性研究.醫藥論壇雜志, 2010, 31(1): 20-22.
34. 徐波, 張銘, 趙驚, 等.急性期血壓控制與血腫擴大關系的對照研究.神經損傷與功能重建, 2010, 5(5): 386-387.
35. 趙艷云.降壓對腦出血早期血腫擴大的影響分析.中國社區醫師:醫學專業, 2012, 14(26): 63.
36. 瞿啟飛, 黃進.高血壓腦出血124例早期積極降壓對控制血腫擴大及預后影響.交通醫學, 2012, 26(5): 457-458.
37. 江明慶.高血壓腦出血后強化降壓對預后的影響.中國現代應用藥學, 2013, 30(7): 785-788.
38. 姜愛鐘, 張建明, 楊光緒.高血壓腦出血早期降壓對血腫擴大的影響.醫學綜述, 2013, 19(23): 4369-4370.
39. 梁士宇.高血壓性腦出血患者早期降壓治療對短期預后影響的研究.現代中西醫結合雜志, 2013, 22(16): 1775-1778.
40. 欒璟煜, 王伊龍.血腫擴大是ICH后死亡和預后不良的決定性因素.中國卒中雜志, 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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