Intensive blood pressure lowering may significantly reduce the risk of recurrent stroke in people who have experienced an intracerebral hemorrhage without increasing the risk of serious adverse effects. This is the conclusion reached by the authors of a large meta-analysis published in The Lancet Neurology.
The researchers analyzed data from four randomized controlled trials involving 2,944 people who had experienced an intracerebral hemorrhage. The participants were followed for up to six years.
A recurrent stroke occurred in 6.5% of patients receiving intensive antihypertensive treatment, compared with 10.4% of those receiving standard or less-intensive treatment. Thus, intensive blood pressure lowering was associated with a 38% reduction in the risk of recurrent stroke.
The main contribution to this result came from a reduction of approximately 61% in the risk of recurrent intracerebral hemorrhage. At the same time, serious adverse events were no more common: they were reported in about 29% of patients in the intensive-treatment group and 33% in the control group.
Particularly notable was the fact that the benefit persisted even among patients whose blood pressure was already within the traditionally recommended target range. Among people with a baseline systolic blood pressure of 130 mmHg or lower, recurrent stroke occurred in 13.9% of those in the control group and only 6.2% of those receiving more intensive treatment.
According to the authors’ estimates, treating 1,000 patients in this way for one year could prevent approximately 16 recurrent strokes.
The researchers believe the findings could influence approaches to secondary stroke prevention. At the same time, they emphasize the need to further improve blood pressure control, as it is often hindered by inconsistent medication use and inadequate adjustment of treatment.
Intracerebral hemorrhage remains one of the most severe forms of stroke. More than 3 million cases occur worldwide each year, and approximately one-quarter of survivors subsequently die from recurrent stroke or cardiovascular disease.
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