Intensive blood pressure lowering after ICH cuts recurrent haemorrhage by more than half

The edition in brief

RECAP-ICH pooled individual data from four trials of 2944 adults with previous spontaneous intracerebral haemorrhage (75% Asian). An 11.2 mm Hg lower systolic pressure over a median 42 months reduced first recurrent stroke from 10.4% to 6.5% (HR 0.62, 95% CI 0.48 to 0.80), mainly through fewer recurrent haemorrhages (5.6% vs 2.2%, HR 0.39). Serious adverse events were not increased, effects were consistent across subgroups, and a 1% absolute benefit accrued in about six months. The American Academy of Neurology and American Headache Society have updated their guideline on pharmacological migraine prevention in adults, covering when to start, which drug to choose in comorbidity, pregnancy, older age and medication overuse, and when to stop. PREVAIL found once-weekly subcutaneous gefurulimab, a C5-blocking nanobody, improved MG-ADL by 1.6 points more than placebo at 26 weeks in AChR-antibody-positive generalised myasthenia, with onset within a week. STRATEGY found adding intravenous tirofiban to aspirin did not reduce early deterioration or new stroke in branch atheromatous disease (17.1% vs 19.6%, HR 0.88, 0.65 to 1.19).