Abstract Number: Esoc2026lt12 Lt12 - Blood Pressure Lowering in Relation to Patient Characteristics and Intensity of Treatment in Intracerebral Hemorrhage: Individual Patient Data Meta-Analysis of Randomized Trials

Abstract Background and aims Although blood pressure (BP) lowering is central to secondary prevention after spontaneous intracerebral hemorrhage (ICH), uncertainties persist regarding the balance of benefits and risks in relation to the intensity of treatment in particular patients, such as the elderly. Methods An individual participant data meta-analysis of RCT in ICH patients (ESPRIT, PROGRESS, RESPECT, and TRIDENT). Intention-to-treat analysis of the primary outcome - time to first recurrent stroke - was undertaken in a fitted one-stage Cox model with a random effect for trial and covariate adjustment. Heterogeneity of treatment in several predefined subgroups was performed by adding the subgroup variable and its interaction with the intervention as fixed effects to the main model. Results The IPDMA included 2944 patients (mean age 59.6 yrs, 33.0% females, and 75.0% Asians) at a median 81 days (IQR 34-256) post-ICH. For an overall mean between-group DBP of 11/5 mmHg over a mean of 40 months of follow-up, recurrent stroke occurred in 96 (7.1%) in the active group versus 152 (11.4%) in the control group (adjusted hazard ratio 0·61, 95%CI 0.48-0.79), with serious adverse events in 311 (20.9%) and 388 (26.6%) of the groups, respectively. There was not heterogeneity of the effect across subgroups. Conclusions Intensive long-term BP lowering after ICH in reducing recurrent stroke benefits all types of patients without serious harms. Conflict of interest