A Prospective Multicenter Study to Evaluate the Feasibility and Safety of Aggressive Antihypertensive Treatment in Patients With Acute Intracerebral Hemorrhage

Abstract

The authors performed a multicenter prospective observational study to evaluate the feasibility and safety of intravenous antihypertensive protocol for acute hypertension in patients with intracerebral hemorrhage (ICH). Twenty-seven patients with ICH and acute hypertension (mean age 61.37 +/- 14.27; 10 were men) were treated to maintain the systolic blood pressure (BP) below 160 mm Hg and diastolic BP below 90 mm Hg within 24 hours of symptom onset. Neurological deterioration (defined as a decrease in initial Glasgow Coma Scale score > or = 2) was observed in 2 (7.4%) of 27 patients during treatment. Among patients who underwent follow-up computed tomography, hematoma expansion (more than 33% increase in hematoma size at 24 hours) was observed in 2 (9.1%) of 22 patients. Patients treated within 6 hours of symptom onset were more likely to be functionally independent (modified Rankin scale < or = 2) at 1 month compared with patients who were treated between 6 and 24 hours (8 of 18 versus 0 of 9,P = .03). Aggressive pharmacological treatment of acute hypertension in patients with ICH can be initiated early with a low rate of neurological deterioration and hematoma expansion.

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

“…There is potential benefit of reducing rates of hematoma expansion with systemic blood pressure reduction versus the potential provocation of ischemia in the perihematoma region [24,30,31]. Recent data from pre-clinical and clinical studies have supported the relative safety of blood pressure reduction in acute intracerebral hemorrhage, although the benefit remains unclear [32,33]. Patients with subarachnoid hemorrhage remain at risk of second rupture acutely following an initial rupture of intracranial aneurysm [34].…”

Blood Pressure Control in Neurological ICU Patients: What is Too High and What is Too Low?

“…There was also no effect of treatment on clinical outcomes at 90 days [36]. Smaller, nonrandomized studies have also found that more aggressive BP lowering is associated with strong trends toward reduced hematoma enlargement [35][36][37][38][39].…”

Recommendations for Stroke Management: Update 2003

“…The mean arterial pressure should be maintained at or below 130 mm Hg for patients with ICH and a history of hypertension [206][207][208] . Keeping the systolic blood pressure in acute ICH below 160 mm Hg and diastolic below 90 mm Hg leads to the growth of hematoma in 9% of patients as compared with 38% of patients in a study where the primary target was not blood pressure measurement 190,209 . In patients with known prior hypertension or signs of chronic hypertension, based on limited data, an upper limit of blood pressure should be 180/105 mm Hg, and in patients without known hypertension, the upper recommended limit is 160/95 mm Hg 22 .…”