Background and aim

There is a current debate on the best approach for blood pressure (BP) reduction in patients with spontaneous intracerebral hemorrhage (ICH). Through this scoping review, we aimed to examine how research on reducing BP in ICH patients has been conducted and to clarify the evidence on which approach is the best (intensive vs. standard BP reductions).

Methods

We performed a scoping review and overview of reviews of the literature. We systematically searched clinical practice guidelines (CPGs), systematic reviews (SRs), and randomized controlled trials (RCTs) that compared intensive versus standard BP reduction. We searched in three databases from inception until March 2020. Two independent authors conducted the study selection, data extraction, quality assessment, and overlapping analysis of SRs. We performed a description and critical appraisal of the current body of evidence.

Results

We included three CPGs (with moderate to high quality); all of them recommended intensive reduction in specific clinical settings. We included eight SRs (with high overlap and critically low quality): two supported intensive reduction and four supported its safety, but not effectiveness. One SR reported that patients with intensive reduction had a significant risk of renal adverse events. We included seven RCTs (with limitations in randomization process); trials with large population did not found significant differences in mortality and disability. One RCT reported a significantly higher number of renal adverse events.

Conclusions

CPGs support the use of intensive BP reduction; however, most recent SRs partially supported or did not support it due to the association with renal events. It seems the range goal between 140 and 180 mmHg could be safe and equally effective than intensive reduction. We recommend further research in serious and non-serious events promoted by intensive reduction and outcomes homogenization across studies to ensure correct comparison.

中文翻译：

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自发性脑出血中血压降低的循证评估：范围审查和概述

背景和目的

目前对于自发性脑出血 (ICH) 患者降低血压 (BP) 的最佳方法存在争议。通过该范围审查，我们旨在检查如何进行 ICH 患者降压研究，并阐明哪种方法最好（强化降压与标准降压）的证据。

方法

我们对文献进行了范围审查和综述。我们系统地检索了比较强化降压与标准降压的临床实践指南 (CPG)、系统评价 (SR) 和随机对照试验 (RCT)。从开始到 2020 年 3 月，我们在三个数据库中进行了搜索。两位独立作者对 SR 进行了研究选择、数据提取、质量评估和重叠分析。我们对现有证据进行了描述和批判性评估。

结果

我们包括了三个 CPG（质量中等到高质量）；他们都建议在特定的临床环境中大量减少。我们纳入了 8 个 SR（重叠度高且质量极低）：两个支持强化减少，四个支持其安全性，但不支持有效性。一位 SR 报告说，强化减量的患者发生肾脏不良事件的风险很大。我们纳入了七项随机对照试验（随机化过程存在局限性）；大规模人群的试验没有发现死亡率和残疾的显着差异。一项 RCT 报告了显着更高数量的肾脏不良事件。

结论

CPG 支持使用强化降压；然而，由于与肾脏事件有关，最近的 SR 部分支持或不支持它。似乎 140 到 180 mmHg 之间的范围目标可能是安全的，并且与强化减少同样有效。我们建议进一步研究通过强化减少和跨研究结果同质化促进的严重和非严重事件，以确保正确比较。