TOPLINE

Intensive blood pressure-lowering treatment after spontaneous intracerebral hemorrhage (ICH) was associated with a significant reduction in recurrent stroke risk, primarily by preventing recurrent hemorrhage, a meta-analysis showed.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis of randomized controlled trials evaluating long-term blood pressure lowering for secondary prevention in adults with a history of spontaneous ICH. Eligible trials were those that compared intensive treatment for lowering blood pressure (fixed-dose antihypertensive therapy or titrated target-based strategies) with a control treatment (placebo or standard blood pressure management). 
• Four trials (ESPRIT, PROGRESS, RESPECT, and TRIDENT) conducted across multiple countries were included in the analysis. They involved 2944 participants (mean age, 59.6 years; 33% women; 75.3% Asian), with 1487 in the intensive-treatment group and 1457 in the control-treatment group. 
• The primary outcome was the first recurrent stroke of any type. Secondary outcomes included the occurrence of major adverse cardiovascular events (MACEs), ICH, ischemic stroke, and cardiovascular death, and safety was assessed through the incidence of any serious adverse event.
• The analysis was adjusted for age, sex, and history of hypertension or diabetes. The median follow-up was 42 months.

TAKEAWAY

• Recurrent stroke of any type occurred in 6.5% of participants in the intensive-treatment group compared with 10.4% of participants in the control group (adjusted hazard ratio [aHR], 0.62; P = .0002). 
• The reduction was driven by recurrent ICH events being less prevalent in the intensive-treatment group vs the control group (2.2% vs 5.6%; aHR, 0.39; P < .0001). MACEs also were less prevalent in the intensive-treatment group than in the control group (8.8% vs 13%; aHR, 0.67; P = .0005).
• Treatment effects were consistent across prespecified subgroups including age, sex, region, baseline blood pressure, and time since the index event. The time to achieve absolute risk reduction for recurrent stroke of 1%, 2%, and 3% were 6.1 months, 14.3 months, and 24 months, respectively. 
• Serious adverse events occurred in a smaller proportion of patients in the intensive-treatment group than in the control group (28.9% vs 33%; aHR, 0.82; P = .015). 

IN PRACTICE

“Generally, guidelines recommend treatment to a target of less than 130/80 mm Hg, but our study showed that patients at or below this threshold can still face a significant risk of recurrent stroke. Preventing stroke recurrence requires us to address the persistent barriers to blood pressure control, such as poor treatment adherence and therapeutic inertia,” senior investigator Craig Anderson, senior professorial fellow, The George Institute for Global Health, University of New South Wales, Sydney, Australia, said in a press release. 

SOURCE

The study was led by Xia Wang, PhD, The George Institute for Global Health, University of New South Wales. It was published online on August 12 in The Lancet Neurology.

LIMITATIONS

The study was limited by a predominantly Asian and relatively young cohort, trial participation criteria, presence of run-in phases, and the inclusion of data from older trials.

DISCLOSURES

The study received no funding. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.