A systematic review and meta-analysis of four clinical trials evaluated the effects of blood pressure (BP)-lowering treatment on recurrent stroke and the timing of its benefits in patients with spontaneous intracerebral hemorrhage (n = 2,944; mean age, 59.6 years). Over a median follow-up of 42 months, intensive BP lowering reduced the hazard of first recurrent stroke of any type compared with control (6.5% vs 10.4%; adjusted hazard ratio [HR], 0.62). This reduction was driven mainly by fewer recurrent intracerebral hemorrhages (2.2% vs 5.6%; aHR, 0.39).

Serious adverse events were also less frequent with BP-lowering treatment than with control (28.9% vs 33.0%). Treatment effects were consistent across subgroups, including age, sex, region, background BP-lowering treatment, baseline BP, and time since the index event. The estimated time to achieve a 1% absolute benefit was 6.1 months.…