{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:46:50Z","timestamp":1788929210673,"version":"build-2803163510"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n Intracerebral hemorrhage carries high mortality and long-term disability. The optimal blood pressure (BP) management strategy\u2014aggressive vs. conservative lowering\u2014remains uncertain. This review compares both strategies.<\/jats:p>\n <\/jats:sec>\n \n DATA SOURCES:<\/jats:title>\n Articles from PubMed, Web of Science, Embase, and Cochrane were screened to August 2025.<\/jats:p>\n <\/jats:sec>\n \n STUDY SELECTION:<\/jats:title>\n Only randomized open-label blinded-endpoint trials were included.<\/jats:p>\n <\/jats:sec>\n \n DATA EXTRACTION:<\/jats:title>\n Patient characteristics, inclusion criteria, interventions, and outcomes were independently extracted by two authors; conflicts were resolved by a third.<\/jats:p>\n <\/jats:sec>\n \n DATA SYNTHESIS:<\/jats:title>\n \n Eight randomized controlled trials (12,669 patients; median age 63 yr; 60% male) met inclusion. No significant differences emerged between aggressive and conservative strategies for excellent functional outcome (risk ratio [RR], 1.07; 95% CI, 0.99\u20131.16;\n p<\/jats:italic>\n = 0.94;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 33%), good functional outcome (RR, 1.09; 95% CI, 0.99\u20131.20;\n p<\/jats:italic>\n = 0.07;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 51%), 90-day mortality (RR, 0.90; 95% CI, 0.77\u20131.05;\n p<\/jats:italic>\n = 0.18;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 0%), or hematoma growth (RR, 0.85; 95% CI, 0.66\u20131.10;\n p<\/jats:italic>\n = 0.22;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 48%). Aggressive BP lowering was associated with fewer adverse events (RR, 0.87; 95% CI, 0.76\u20130.99;\n p<\/jats:italic>\n = 0.03;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 59%). Sensitivity analyses showed significant benefits of the aggressive approach for good recovery (RR, 1.05; 95% CI, 1.01\u20131.10;\n p<\/jats:italic>\n = 0.02;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 0%), although not confirmed in the subgroup analyses (RR, 1.09; 95% CI, 0.97\u20131.23;\n p<\/jats:italic>\n = 0.14;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 61%). For adverse events, subgroup analyses consistently favored the aggressive strategy (RR, 0.81; 95% CI, 0.74\u20130.88;\n p<\/jats:italic>\n < 0.01;\n I<\/jats:italic>\n 2<\/jats:sup>\n = 0%). No clear association with hematoma growth emerged, largely due to heterogeneity.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Aggressive and conservative BP lowering yielded similar outcomes for functional recovery, mortality, and hematoma growth. Aggressive BP lowering was linked to fewer adverse events, with some subgroup analyses suggesting modest functional benefits.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007240","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T14:03:57Z","timestamp":1784729037000},"page":"2410-2418","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Aggressive vs. Conservative Blood Pressure Reduction in Acute Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1097","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6242-7279","authenticated-orcid":false,"given":"Gabriel","family":"Semione","sequence":"first","affiliation":[{"name":"Department of Medicine, University of West Santa Catarina, Joa\u00e7aba, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio Yuri","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Deparment of Neurosurgery, Northwell, New Hyde Park, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Gunkan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Vilardo","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Catholic University of Brasilia, Bras\u00edlia, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Henrique da Silva","family":"Tobaldini","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of West Santa Catarina, Joa\u00e7aba, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Lebkuchen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Adauto Botelho Hospital, Pinhais, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Januario Campos","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhon E.","family":"Bocanegra-Becerra","sequence":"additional","affiliation":[{"name":"Academic Department of Surgery, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Bertani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wellingson","family":"Paiva","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of S\u00e3o Paulo, S\u00e3o Paulo, 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