The Effect Of Intensive Hypertension Treatment In Patients With Intracranial Hemorrhage: A Systematic Review And Meta-analysis

BackgroundTo determine whether intensive hypertension treatment reduces hematoma growth, death at90days, substantial growth of hematoma, early neurological deterioration when compared toguideline treatment of hypertension in patients with intra cerebral hemorrhage.MethodsWe performed a systematic review of published studies evaluating the outcome effect ofintensive hypertension treatment compared to guideline treatment in intra-cerebral hemorrhagepatients published between1990and2013; the search performed by MEDLINE and EMBASE,The methodological quality of the studies was assessed independently by two reviewers. Foreach study the grades of recommendation were determined. We used the random-effect model tocombine data. Pooled odd ratio (OR) and95%confidence intervals (CI) were calculated.Results4studies met the inclusion criteria; with a total of3350patients,1630of them wereguideline group, and1662of them were intensive group.3studies reported the mean absoluteincrease of blood in the two groups. None of them showed significant difference. After combingthe data of the3studies together, the results showed that the mean absolute increase of blood issignificantly small in intensive group when compare to guideline group (MD=-1.54,95%CI=-2.92to-0.16, p <0.05). No statistical heterogeneity was found between the3RCTs (pQ=0.67,I2=0%).3studies reported the mortality rates at90days. None of them showed significantdifference. After combing the data of the3studies together, the results showed that there is nosignificant difference of mortality rates between the two groups (OR=0.97,95%CI=0.79to1.20, p>0.05). No statistical heterogeneity was found between the3RCTs (pQ=0.83, I2=0%). 3studies reported the poor outcome at90days. None of them showed significant difference.After combing the data of the3studies together, the results showed that the number of patientswith poor outcome is less in intensive group compare to guideline group (OR=0.89,95%CI=0.77to1.02), but the difference is not significant (p>0.05). No statistical heterogeneity wasfound between the3RCTs (pQ=0.60, I2=0%).4studies reported the number of patients with substantial growth of hematoma (an increasein hematoma volume of>33%). None of them showed significant difference. After combing thedata of the4studies together, the results showed that there is no significant difference of thenumber of patients with substantial growth of hematoma between the two groups (OR=0.91,95%CI=0.59to1.50, p>0.05). No statistical heterogeneity was found between the4RCTs((pQ=0.16, I2=41.3%).4studies reported the number of patients with early neurological deterioration. None ofthem showed significant difference. After combining the data of the4studies together, theresults showed that there is no significant difference of the number of patients with earlyneurological deterioration between the two groups (OR=0.97,95%CI=0.80to1.18, p>0.05).No statistical heterogeneity was found between the4RCTs ((pQ=0.88, I2=0%).2studies reported the number of patients with a serious adverse event. None of themshowed significant difference. After combing the data of the2studies together, the resultsshowed that there is no significant difference the number of patients with a serious adverse eventbetween the two groups (OR=0.98,95%CI=0.83to1.16, p>0.05). No statisticalheterogeneity was found between the2RCTs ((pQ=0.98, I2=0%).ConclusionThe results of the present systematic review showed that intensive hypertension treatment isas safe as guideline treatment with probably better outcome. We recommend further studies inthis area.