Abstract:

Objective To evaluate the efficacy and safety of intensive blood pressure control for patients with intracerebral hemorrhage (ICH). Methods Retrieve relevant randomized controlled trials (RCTs) from online databases (January 1, 1980-September 30, 2015) as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: intracerebral hemorrhage, ICH, blood pressure, intensive, and acute. Selection of studies was performed according to pre-designed inclusion and exclusion criteria. Quality of studies was evaluated by using Jadad Scale. All data were pooled by RevMan 5.3 software for Meta-analysis. Results The research enrolled 3322 articles, from which 4 articles with Jadad score ≥ 4 were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 3360 ICH patients were included. Meta-nalysis showed intensive blood pressure control did not decrease the incidence of hematoma enlargement > 1/3 from baseline to 24 h (RR = 0.910, 95%CI: 0.750-1.090; P = 0.310), neither associated with a favorable possibility on modified Rankin Scale (mRS) score ≤ 2 at 90 d of treatment (RR = 1.070, 95% CI: 0.990-1.150; P = 0.090). Intensive blood pressure control did not increase National Institutes of Health Stroke Scale (NIHSS) score significantly (RR = 0.950, 95%CI: 0.800-1.120; P = 0.530), nor increase the occurrence of adverse events in circulatory system (RR = 0.910, 95%CI: 0.610-1.370; P = 0.660) or severe hypotension (RR = 0.840, 95% CI: 0.370-1.940; P = 0.690). Conclusions Though intensive blood pressure control is unlikely to stop the enlargement of hematoma in a short term, it is likely to improve long-tem prognosis and reduce the rate of morbidity and mortality. Intensive blood pressure control is safe as it neither increase the symptoms of nervous system damage, nor the occurrence rate of circulatory system adverse events or severe hypotension.

Key words: Cerebral hemorrhage, Antihypertensive agents, Meta-analysis

摘要：

目的 评价强化控制血压治疗脑出血的有效性和安全性。方法 以intracerebral hemorrhage、ICH、blood pressure、intensive、acute 等英文检索词，计算机检索1980 年1 月1 日-2015 年9 月30 日美国国立医学图书馆生物医学信息检索系统、荷兰医学文摘、Cochrane图书馆等数据库收录的关于强化控制血压治疗脑出血的随机对照临床试验，采用Jadad 量表和RevMan 5.3 统计软件进行文献质量评价和Meta 分析。结果 共获得3322 篇文献，经剔除重复和不符合纳入标准者，最终纳入4 项较高质量（Jadad 评分≥ 4 分）的临床试验共3360 例脑出血病例。Meta 分析显示：强化控制血压早期并不能减少发病24 h 内血肿体积增加> 1/3 的病例数（RR = 0.910，95%CI：0.750 ~ 1.090；P = 0.310），亦不增加治疗90 d 时改良Rankin 量表评分≤ 2 分的病例数（RR = 1.070，95%CI：0.990～1.150；P = 0.090）和美国国立卫生研究院卒中量表评分（RR = 0.950，95%CI：0.800～1.120；P = 0.530）以及循环系统不良事件（RR = 0.910，95%CI：0.610～1.370；P = 0.660）和严重低血压（RR = 0.840，95%CI：0.370 ~ 1.940；P = 0.690）发生率。结论 强化控制血压治疗脑出血并不能在短期内减少血肿增加，但有可能改善患者远期预后，降低病残率和病死率；不增加神经系统损害症状，以及循环系统不良事件和严重低血压发生率。

关键词: 脑出血, 抗高血压药, Meta分析