Evidence map›Paper›PMID 34732465›Full record

SynthesisJournal of neurology, neurosurgery, and psychiatry2022

Early lowering of blood pressure after acute intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data.

Tom J Moullaali, Xia Wang, Else Charlotte Sandset, Lisa J Woodhouse, Zhe Kang Law, Hisatomi Arima, Kenneth S Butcher, John Chalmers, Candice Delcourt, Leon Edwards and 13 more

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of neurology, neurosurgery, and psychiatry, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 4 pooled it
4.7field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 4 syntheses or guidelines pooled it, 67 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors at 15 institutions in 9 countries.

Tom J Moullaali *The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.ORCID 0000-0002-6786-3623
Xia Wang *The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.ORCID 0000-0002-1684-7076
Else Charlotte Sandset *Department of Neurology, Oslo University Hospital, Oslo, Norway.
Lisa J Woodhouse *Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Zhe Kang Law *Stroke Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK.ORCID 0000-0002-7900-9037
Hisatomi ArimaDepartment of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan.
Kenneth S ButcherPrince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.
John ChalmersThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Candice DelcourtThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.ORCID 0000-0003-2257-4286
Leon EdwardsNeurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Salil GuptaDepartment of Neurology, Army Hospital Research and Referral, New Delhi, India.
Wen JiangDepartment of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Sebastian KochDepartment of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
John PotterStroke Research Group, Norfolk and Norwich University Hospital, UK.
Adnan I QureshiZeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO.
Thompson G RobinsonUniversity of Leicester, Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Leicester, UK.
Rustam Al-Shahi SalmanCentre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Jeffrey L SaverDepartment of Neurology and Comprehensive Stroke Center, UCLA, Los Angeles, California, USA.
Nikola SpriggStroke Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Joanna M WardlawCentre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.ORCID 0000-0002-9812-6642
Craig S AndersonThe George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia canderson@georgeinstitute.org.au.
Philip M BathStroke Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
Blood Pressure in Acute Stroke (BASC) Investigators
The George Institute for Global Health · GBNottingham University Hospitals NHS Trust · GBThe University of Sydney · AUUniversity of Edinburgh · GBArmy Hospital Research and Referral · INFukuoka University · JPOslo University Hospital · NORehabilitation Institute of Kansas City · USUCLA Health · USUniversity of East Anglia · GBUniversity of Leicester · GBUniversity of Miami · USUniversity of Nottingham · GBUNSW Sydney · AUXijing Hospital · CN

Funding

British Heart Foundation FS/17/53/33119Medical Research Council G0501797
6 · The paper itself

Abstract

objectiveTo summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).

methodsA prespecified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents versus placebo or intensive versus guideline BP-lowering targets for adults <7 days after ICH onset. The primary outcome was function (distribution of scores on the modified Rankin scale) 90 days after randomisation. Radiological outcomes were absolute (>6 mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted using generalised linear mixed models with prespecified covariables and trial as a random effect.

resultsOf 7094 studies identified, 50 trials involving 11 494 patients were eligible and 16 (32.0%) shared patient-level data from 6221 (54.1%) patients (mean age 64.2 [SD 12.9], 2266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6-5.3). Active/intensive BP-lowering interventions had no effect on the primary outcome compared with placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95% CI 0.88 to 1.06; p=0.50), but there was significant heterogeneity by strategy (p

interpretationOverall, a broad range of interventions to lower BP within 7 days of ICH onset had no overall benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent. PROSPERO REGISTRATION NUMBER: CRD42019141136.

Indexed as

AdultAgedAntihypertensive AgentsBlood PressureCerebral HemorrhageFemaleHumansHypertensionMaleMiddle AgedRandomized Controlled Trials as TopicTreatment OutcomeAntihypertensive Agentsmeta-analysisstroke

Identifiers

PMID34732465
PMCPMC8685661
OpenAlexW3206422306

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.