Supplementary Material for: How Should We Lower Blood Pressure after Cerebral Hemorrhage? A Systematic Review and Meta-Analysis

<strong><em>Background:</em></strong> The optimal treatment of high blood pressure (BP) after acute intra-cerebral hemorrhage (ICH) is controversial. <b><i>Summary:</i></b> The aim of the study was to evaluate the safety and efficacy of early intensive vs. conservative BP lowering treatment in patients with ICH. Randomized controlled trials with active and control groups receiving intensive and conservative BP lowering treatments were identified. The following outcomes were assessed: 3-month mortality and combined death or major disability, 24-h hematoma growth, early neurological deterioration, occurrence of hypotension, severe hypotension, and serious treatment-emergent adverse events. Five trials were included involving 4,350 participants, 2,162 and 2,188 for intensive and conservative treatment groups, respectively. The pooled risk ratio of 3-month death or major disability was 0.96 (0.91-1.01) and the weighted mean difference in absolute hematoma growth was -1.53 (95% CI -2.94 to -0.12) mL in the intensive compared to conservative BP-lowering. There were no differences across the treatments in the incidence rates of 3-month mortality, early neurological deterioration, hypotension, and treatment-related adverse effects other than renal events. <b><i>Key Messages:</i></b> The early intensive anti-hypertensive treatment was overall safe and reduced the hematoma expansion in patients presenting with acute-onset spontaneous ICH and high BP levels.

**背景**：急性脑出血（intra-cerebral hemorrhage, ICH）后高血压（high blood pressure, BP）的最优治疗方案尚存争议。
**总结**：本研究旨在评估急性脑出血患者早期强化与保守降压治疗的安全性与有效性。本研究筛选了设有试验组与对照组、分别接受强化降压与保守降压治疗的随机对照试验。评估的结局指标包括：3个月死亡率、死亡或重度残疾复合结局、24小时血肿增大体积、早期神经功能恶化、低血压发生情况、严重低血压以及严重治疗相关不良事件。最终共纳入5项试验，涉及4350名受试者，强化降压组与保守降压组分别有2162例与2188例受试者。与保守降压组相比，强化降压组的3个月死亡或重度残疾合并风险比为0.96（95%置信区间0.91~1.01），血肿绝对增大体积的加权均数差为-1.53（95%CI：-2.94~-0.12）mL。在3个月死亡率、早期神经功能恶化、低血压发生率以及除肾脏事件外的治疗相关不良事件发生率方面，两组未观察到显著差异。
**核心结论**：对于急性起病的自发性脑出血伴高血压患者，早期强化降压治疗整体安全性良好，且可减少血肿扩大。