Evidence map›Paper›PMID 40739079›Full record

SynthesisNeurocritical care2025

Intensive Blood Pressure Lowering for Intracerebral Hemorrhage: A Systematic Review and Updated Meta-analysis of Randomized Controlled Trials.

Pedro Henrique Reginato, Gabriel Paulo Mantovani, Vinicius Furtado da Silva Castro, Giovanna Salema Pascual, Letícia Felício Saldanha, Henrique Alexsander Ferreira Neves, Leonardo Zumerkorn Pipek

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Pedro Henrique ReginatoFaculty of Medicine, Federal University of Paraná, Paraná, Brazil. pedroh.reginato@gmail.com.ORCID http://orcid.org/0009-0004-3406-0770
Gabriel Paulo MantovaniWestern University, London, Canada.
Vinicius Furtado da Silva CastroHospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil.
Giovanna Salema PascualUniversity of Bologna, Bologna, Italy.
Letícia Felício SaldanhaFederal University of Ceará, Ceará, Brazil.
Henrique Alexsander Ferreira NevesFaculty of Medicine, Federal University of Paraná, Paraná, Brazil.
Leonardo Zumerkorn PipekHospital das Clínicas da Faculdade de Medicina de São Paulo, São Paulo, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntracerebral hemorrhage (ICH) is often associated with elevated blood pressure (BP), increasing the risk of persistent and recurrent hemorrhage, disability, and death. Previous studies have reported conflicting results regarding BP management, particularly concerning treatment timing and optimal targets. The aim of this review was to perform a systematic review and meta-analysis comparing intensive BP lowering with standard management in patients with ICH.

methodsPubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing intensive BP lowering (target < 140 mm Hg) with standard management in patients with ICH. Outcomes included good functional outcome (modified Rankin scale [mRS] score 0-2), poor functional outcome (mRS score 3-6), all-cause mortality, and substantial hematoma enlargement. Subgroup analyses assessed (1) BP target thresholds, (2) randomization window (< 6 h vs. ≥ 6 h from symptom onset), and (3) BP target type (systolic blood pressure based vs. mean arterial pressure based). All analyses were conducted based on risk ratios (RR) and 95% confidence intervals (CIs) using a random-effects model.

resultsEleven RCTs (13,625 patients; 6,755 in the intensive group) were included. Intensive BP lowering was associated with a significant reduction in poor functional outcome (mRS score 3-6; RR 0.93, 95% CI 0.90-0.96; p < 0.01) and an increase in good functional outcome (mRS score 0-2; RR 1.09, 95% CI 1.01-1.18; p = 0.03). All-cause mortality (RR 0.86, 95% CI 0.79-0.94; p < 0.01) and substantial hematoma enlargement (RR 0.83, 95% CI 0.73-0.95; p < 0.01) were also significantly lower in the intensive group. The subgroup analyses revealed no significant interactions.

conclusionsThese findings suggest that intensive BP lowering in ICH might be associated with improved functional outcomes and lower risks of death, disability, and hematoma enlargement, supporting its potential role in acute management.

Indexed as

Antihypertensive AgentsBlood PressureCerebral HemorrhageHypertensionOutcome Assessment, Health CareRandomized Controlled Trials as TopicHumansAntihypertensive AgentsBlood pressureHealth careHematoma expansionIntracerebral hemorrhageOutcome assessment

Identifiers

PMID40739079

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.