Neuroanaesthesia & neurocritical care
Aggressive vs. Conservative Blood Pressure Reduction in Acute Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors' conclusion
Aggressive and conservative BP lowering yielded similar outcomes for functional recovery, mortality, and hematoma growth. Aggressive BP lowering was linked to fewer adverse events, with some subgroup analyses suggesting modest functional benefits.
Study context
- Population
- Patients with acute intracerebral hemorrhage
- Participants
- 12,669 patients · 8 RCTs
- Comparison
- Aggressive vs conservative blood pressure (BP) lowering
Methodological detailsrandomised open-label blinded-endpoint trials only
- Randomised open-label blinded-endpoint trials only
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Excellent functional outcomeI2 = 33% | 1.07 (0.99–1.16) | P = 0.94 | |
| Good functional outcomeI2 = 51% | 1.09 (0.99–1.20) | P = 0.07 | |
| Mortality · 90 daysI2 = 0% | 0.90 (0.77–1.05) | P = 0.18 | |
| Hematoma growthI2 = 48% | 0.85 (0.66–1.10) | P = 0.22 | |
| Good recovery (sensitivity analysis)I2 = 0% | 1.05 (1.01–1.10) | P = 0.02 | |
| Good recovery (subgroup analyses)I2 = 61% | 1.09 (0.97–1.23) | P = 0.14 | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Adverse eventsI2 = 59% | 0.87 (0.76–0.99) | P = 0.03 | |
| Adverse events (subgroup analyses)I2 = 0% | 0.81 (0.74–0.88) | P < 0.01 | |
| 0.512Relative risk (log scale) |
Original publication
Aggressive vs. Conservative Blood Pressure Reduction in Acute Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Crit Care Med. Published 22 July 2026. doi:10.
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