{
  "abstract": "Background Elevated systolic blood pressure (SBP) is typical after spontaneous intracerebral hemorrhage (ICH) and is linked with hematoma expansion and poor neurological outcomes. Randomized trials have evaluated intensive SBP lowering strategies, however, effects on functional recovery and mortality remain heterogenous.Hypothesis The clinical impact of early intensive blood pressure lowering in acute spontaneous ICH depends on combining it prior to subsequent interventions (neuroprotective or surgical), because BP lowering alone mainly stabilizes hematoma expansion but does not reliably functional outcomes or survival without additional intervention.Methods We searched MEDLINE, Embase, Central, PubMed, and other clinical trial registries for randomized controlled trials evaluating intensive vs. Standard SBP lowering in adults with acute spontaneous ICH. Eligible studies enrolled patients within 6 hours of symptom onset and compared intensive SBP targets (typically 110-139 mmHg or <140 mmHg) with standard targets (140-179 mmHg or <180 mmHg). Primary outcomes included hematoma expansion and functional independence (modified Rankin Scale {mRS} 0-2). Secondary outcomes included mortality and major neurological complications. Follow-up periods lasted from 30-90 days across studies. Results: Among major randomized trials enrolling several thousand patients, intensive SBP lowering was regularly associated with reduced hematoma expansion, with observed rates of significant expansion (>6 mL or ≥33%) lower in intensive-treatment groups compared with standard care. Nonetheless, functional outcomes varied considerably: rates of functional independent (mRS 0-2 at 90 days) spanned approximately from the mid-30% to 60% across treatment groups, with no uniform improvement in comparison with standard treatment. Mortality rates were similar between intensive and standard SBP targets across studies, and aggressive lowering to targets near 110-120 mmHg was associated with higher rates of renal complications in some trials. The impact of treatment varied based on achieved SBP, baseline neurological severity, and timing of initial intervention.Conclusions Intensive BP lowering in acute spontaneous intracerebral hemorrhage consistently reduces hematoma expansion but does not reliably improve functional outcomes or survival across heterogeneous patient populations. This dissociation suggests that BP reduction primarily rapidly stabilizes the evolving injury rather than outright preventing it, acting as a temporal bridge that allows neuroprotective or surgical interventions (such as an early decompressive craniectomy) to be performed safely and effectively. Intensive blood pressure lowering should be viewed as a time-critical prerequisite rather than simply combining it with definitive therapy. However, lowering BP is most impactful before or during the early phase of injury, not after the main intervention has already stabilized the hemorrhage, as the damage has already been done and functional outcomes will be less likely to improve. The framework suggests that the clinical impact of BP lowering is determined primarily by how early it is achieved, and therefore reaching target SBP ideally within the first 1-2 hours of hemorrhage onset will be more likely to meaningfully stabilize the hemorrhagic environment and expand the therapeutic window to prevent injury progression in order to increase the likelihood of successful intervention.Disclosures A. Rayaprolu: None.",
  "authors": [
    {
      "affiliations": [
        "Redmond, WA"
      ],
      "name": "A Rayaprolu"
    }
  ],
  "title": "E-141 Early intensive systolic blood pressure lowering with subsequent targeted intervention in acute intracerebral hemorrhage",
  "uid": "9187325f-b5d7-55c1-bcc6-2868b198a462"
}