Design: Systematic review and individual participant data meta-analysis of 4 RCTs
Population: 2944 adults after spontaneous intracerebral haemorrhage
Primary outcome: First recurrent stroke of any type
Effect: 6.5% vs 10.4%; HR 0.62 (0.48–0.80); recurrent ICH HR 0.39 (0.26–0.59)

RECAP-ICH was a systematic review and individual participant data meta-analysis of four randomised trials of long-term blood pressure lowering after spontaneous intracerebral haemorrhage, totalling 2944 patients (mean age 60, 75% Asian), followed for a median of 42 months.

Systolic pressure averaged 11.2 mm Hg lower with treatment. First recurrent stroke occurred in 6.5% against 10.4% (adjusted HR 0.62, 95% CI 0.48–0.80), driven by recurrent haemorrhage: 2.2% against 5.6% (HR 0.39, 0.26–0.59). Serious adverse events were not increased (28.9% vs 33.0%). Effects were consistent across age, sex, region, baseline pressure and time since the bleed. A 1% absolute benefit accrued in about six months.

Blood pressure control after ICH is already recommended; what this adds is confidence that intensive lowering is safe, that the benefit is large and fast, and that it holds in Asian patients — directly relevant in India, where hypertensive haemorrhage is common and follow-up blood pressure often drifts. The trials used different strategies and targets, so the analysis supports lower rather than any single number.

Treat blood pressure firmly after intracerebral haemorrhage; the benefit appeared within six months.
Check blood pressure at every follow-up visit and intensify treatment if it drifts up.
Benefit held regardless of baseline pressure and time since the bleed, so it is not too late to tighten control.
Home blood pressure monitoring helps sustain control between visits.

Why it matters

Recurrent haemorrhage is largely preventable with a treatment every clinic already has.

The statistics, in plain English

A hazard ratio of 0.39 for recurrent haemorrhage means about 61% fewer bleeds. The absolute difference — 3.4 percentage points over about three and a half years — means about 30 patients treated to prevent one recurrent bleed.