The edition · Neurology
Intensive blood pressure lowering after intracerebral haemorrhage cut recurrent stroke by nearly 40%
An individual participant data meta-analysis of four trials and 2,944 patients found an 11.2 mmHg systolic difference reduced first recurrent stroke from 10.4% to 6.5%, driven almost entirely by fewer recurrent haemorrhages. The AAN has also published an updated migraine prevention guideline, and leisure-time exercise lowered dementia risk while occupational activity raised it.
The edition in brief
The finding of the day is unusually clean. RECAP-ICH pooled individual participant data from four randomised trials of blood pressure lowering after spontaneous intracerebral haemorrhage — 2,944 patients, median follow-up 42 months, three-quarters of them Asian. A mean systolic difference of 11.2 mmHg reduced first recurrent stroke of any type from 152 of 1,457 to 96 of 1,487, an adjusted hazard ratio of 0.62. Almost all of that came from recurrent intracerebral haemorrhage, down from 5.6% to 2.2%, a hazard ratio of 0.39. Serious adverse events were slightly fewer in the intensive arm, and the effect held across every prespecified subgroup. The time to a 1% absolute benefit was about six months. The American Academy of Neurology and the American Headache Society have issued an updated guideline on pharmacologic migraine prevention in adults, covering when to start, what to start, and choices in fibromyalgia, obesity, hypertension, pregnancy and lactation, older adults, and medication overuse. Two other findings worth your time. A meta-analysis of 4.2 million people found high leisure-time physical activity associated with less dementia (RR 0.76) while occupational activity went the other way (1.20) — a split that matters more than the headline. And an app-delivered biofeedback programme reduced monthly migraine days by 0.9 against a waitlist, which is statistically clear and clinically modest.
Lowering blood pressure after intracerebral haemorrhage prevents the next one
After spontaneous intracerebral haemorrhage, an 11 mmHg systolic reduction cut first recurrent stroke from 10.4% to 6.5%, driven by a more than halving of recurrent haemorrhage, with no excess of serious adverse events.
The AAN has updated its guideline on pharmacologic migraine prevention
The AAN and American Headache Society have published updated recommendations on starting, choosing, monitoring and stopping pharmacologic migraine prevention, including guidance for pregnancy, obesity, hypertension and medication overuse.
Leisure exercise lowered dementia risk; work and commuting activity raised it
Leisure-time and household activity were associated with lower dementia risk while occupational and commuting activity were associated with higher risk, on evidence the authors themselves rate as very low to low certainty.
App-based biofeedback cut monthly migraine days by 0.9 against a waitlist
Self-administered app-based biofeedback reduced monthly migraine days by 0.9 more than a waitlist over twelve weeks, a statistically clear but clinically modest effect with negligible risk.
Slowly expanding lesions are present in most MS patients and are mostly not paramagnetic rim lesions
Slowly expanding lesions account for about 14% of T2 lesions and are present in 78% of MS patients, but overlap with paramagnetic rim lesions in only 11% of cases — the two markers are not measuring the same thing.
Ask what the control arm did, and whether the exposure was chosen
Before reading an effect size, ask what the control group actually experienced and whether the exposure was chosen — both determine how much of the difference belongs to the intervention.
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