RECAP-ICH is an individual participant data meta-analysis of four randomised trials of blood pressure lowering for secondary prevention after spontaneous intracerebral haemorrhage. It includes 2,944 patients with a mean age of 59.6 years, 75.3% of them Asian, followed for a median 42 months.
The achieved separation was 11.2 mmHg systolic. First recurrent stroke of any type occurred in 96 of 1,487 (6.5%) treated patients and 152 of 1,457 (10.4%) controls, an adjusted hazard ratio of 0.62 with an interval from 0.48 to 0.80. The effect is almost entirely one mechanism: recurrent intracerebral haemorrhage fell from 81 (5.6%) to 33 (2.2%), a hazard ratio of 0.39 with an interval from 0.26 to 0.59.
Two details make this more usable than most meta-analyses. Serious adverse events were slightly lower in the intensive arm — 28.9% against 33.0% — so the usual worry about pushing pressure down in a fragile brain is not supported here. And the estimated time to a 1% absolute benefit was 6.1 months, which is short enough to matter to a patient deciding whether treatment is worth it. Effects were consistent across age, sex, region, baseline pressure and time since the index bleed.
- Three-quarters of participants were Asian, where haemorrhagic stroke burden is highest
- The benefit is specifically against recurrent haemorrhage, not ischaemic stroke
- Serious adverse events were fewer, not more, in the intensively treated arm
- About six months to a 1% absolute benefit — a usable number for a consultation
- Individual participant data, so subgroups are analysed properly rather than by study
The statistics, in plain English
An adjusted hazard ratio of 0.62 with an interval from 0.48 to 0.80 sits comfortably below 1.0, so the direction and rough size are both secure. Individual participant data meta-analysis is a stronger design than pooling published summaries: it lets the analysts apply one definition of the outcome across trials and test subgroups within patients rather than between studies, which is where most subgroup claims go wrong.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free