Continuous Antihypertensive Therapy Throughout the Initial 24 Hours of Intracerebral Hemorrhage

Abstract

Background and Purpose— A short duration (<24 hours) of antihypertensive therapy (AHT) after acute intracerebral hemorrhage (ICH) may be sufficient because active bleeding generally ceases within several hours. We aimed to determine the association between sequential systolic blood pressure (SBP) levels during AHT and outcomes in ICH patients. Methods— In 211 hyperacute ICH patients who underwent AHT based on predefined protocol, the mean of hourly SBP (mSBP) measurements was calculated over 1 to 8 hours (first mSBP), 9 to 16 hours (second mSBP), and 17 to 24 hours (third mSBP) after the initiation of AHT. Outcomes included neurological deterioration (72-hour Glasgow Coma Scale decrease ≥2 or National Instititutes of Health Stroke Scale increase ≥4), hematoma expansion (>33%), and unfavorable outcome (3-month modified Rankin Scale score 4–6). Results— The median first, second, and third mSBPs were 132, 131, and 137 mm Hg, respectively. A higher first mSBP (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.34–4.69 per 10 mm Hg) or second mSBP (OR, 2.08; 95% CI, 1.20–3.80) was independently associated with neurological deterioration, and a higher second mSBP (OR, 1.40; 95% CI, 1.02–2.00) or third mSBP (OR, 1.45; 95% CI, 1.05–2.05) was associated with unfavorable outcome. None of the mSBPs was associated with hematoma expansion. Conclusions— The continuation of AHT throughout the initial 24 hours after ICH may improve outcomes.

Blood Pressure Variability on Antihypertensive Therapy in Acute Intracerebral Hemorrhage

“…Of the 211 patients in the registry, 205 (81 women, median age 65 [interquartile range, 59-75] years, median initial National Institutes of Health Stroke Scale score 13 [8][9][10][11][12][13][14][15][16][17]) whose BP data were available throughout the 24-hour observation period were studied. The Table in the online-only Data Supplement shows the baseline clinical characteristics of the included patients.…”

“…The details were documented previously. 4,8,9 Briefly, the criteria for inclusion are as follows: ≥20 years of age; total Glasgow Coma Scale score ≥5; initial SBP >180 mm Hg; computed tomography <2.5 hours of onset demonstrating a supratentorial intraparenchymal hematoma with manual volume measurement <60 mL; and absence of extensive intraventricular hemorrhage. The study was approved by each institutional ethics and hospital management committee.…”

Mechanism and Therapy of Brain Edema after Intracerebral Hemorrhage

“…A clinical study shows that blood pressure reduction (systolic blood reduction goals are 170-199, 140-169 and 110-139 mm Hg, respectively) can reduce hematoma expansion and brain edema ratio after ICH with no significance between every group [61] . However, some large clinical studies show that intensive and continuous blood pressure reduction in the acute phase of ICH can improve functional outcomes by decreasing the hematoma expansion rate, and blood pressure should be controlled to be under 140/90 mm Hg in the first hour after onset or within 24 h [62][63][64] . And these new therapeutic strategies focusing on multiple inflammatory pathways seem to be more effective than those focusing on single pathways [65] .…”

Association between Blood Pressure and Post-Stroke Cognitive Impairment: A Meta-Analysis

“…After excluding 22 duplicates, 750 titles, and abstracts were reviewed, and 43 full-text articles were assessed. Finally, after excluding 31 studies for ineligible outcomes [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ], participants [ 27 , 28 , 29 ], exposures [ 13 , 30 , 31 , 32 ], study designs [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ], methodological analyses [ 4 , 14 , 15 , 41 , 42 , 43 ], and published languages [ 44 ], 12 articles were identified as eligible and included in this meta-analysis. Fig.…”