The Effect of Intensive Blood Pressure Reduction on Perihematomal Edema After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis.

BACKGROUND: Perihematomal edema (PHE) is a radiological marker of intracerebral hemorrhage (ICH)-induced secondary brain injury. Whether intensive blood pressure (BP) reduction attenuates PHE expansion remains uncertain. We conducted a systematic review and meta-analysis to assess the effect of intensive BP reduction on approximately 24-h PHE expansion in patients with spontaneous ICH. METHODS: MEDLINE, Embase, and the Cochrane Library were searched from database inception to January 2026. Eligible studies compared intensive versus standard BP reduction in patients with spontaneous ICH and reported PHE-related outcomes. Risk of bias was assessed using the Cochrane risk-of-bias tool. Pooled estimates were calculated using the inverse-variance method with a fixed-effect model. RESULTS: Six studies were included in the qualitative synthesis, and 4 studies were included in the quantitative meta-analysis, comprising 1061 patients in the intensive BP reduction group and 966 patients in the standard BP management group. Intensive BP reduction was associated with smaller approximately 24-h PHE expansion than standard BP management (mean difference, -0.50 mL; 95% CI, -0.89 to -0.12; p = 0.010). No statistical heterogeneity was observed (I2 = 0%). CONCLUSIONS: Intensive BP reduction was associated with smaller approximately 24-h PHE expansion in patients with spontaneous ICH. Further standardized studies are needed to confirm the clinical relevance of this effect.