ABSTRACT NUMBER: ESOC2026A204 SYSTOLIC BLOOD PRESSURE TARGETS IN ACUTE INTRACEREBRAL HAEMORRHAGE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF INTENSIVE VERSUS STANDARD CONTROL

Abstract Background and aims Optimal systolic blood pressure (SBP) reduction in acute intracerebral haemorrhage remains contested despite widespread clinical adoption of intensive treatment. Aim To compare outcomes of intensive (SBP <140 mmHg) versus standard (SBP <180 mmHg) blood pressure control following intracerebral haemorrhage. Methods Randomised controlled trials reporting functional outcomes, haematoma expansion, and safety endpoints were included. Primary outcome was mRS 0–3 at 90 days. Secondary outcomes included haematoma growth, neurological deterioration, mortality, and renal adverse events. Pooled effect estimates were calculated using random-effects models. Results Eight trials totalling 6,882 participants were analysed. Intensive SBP lowering did not significantly improve functional outcome (OR 1.06, 95% CI 0.95–1.19; p = 0.31; I2 = 12%) but significantly reduced haematoma expansion (OR 0.78, 95% CI 0.66–0.92; p = 0.003; I2 = 0%). Mortality did not differ (OR 0.96, 95% CI 0.82–1.12; p = 0.63), but renal adverse events were more frequent with intensive treatment (OR 1.31, 95% CI 1.05–1.63; p = 0.02). Neurological deterioration was modestly lower in the intensive group. Conclusions Intensive SBP lowering reduces haematoma expansion but does not clearly improve functional outcomes and carries increased renal risks. Tailored SBP strategies may be warranted. Conflict of interest all authors have has nothing to disclose