Effects of Intensive Blood Pressure Reduction on Acute Intracerebral Hemorrhage: A Systematic Review and Meta-analysis

Gong, Shusheng; Lin, Chao; Zhang, Danfeng; Kong, Xiangyi; Chen, Jigang; Wang, Chunhui; Liu, Zhenxing; Chen, Rongbin; Sheng, Ping; Yan, Dong; Hou, Lingling

doi:10.1038/s41598-017-10892-z

Cited by 28 publications

(13 citation statements)

References 36 publications

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“…Meta-analyses of these trials and other smaller studies showed that early intensive blood pressure lowering was safe, but without functional or mortality benefit. 78–82 In contrast, a linear association between systolic blood pressure achieved in the first 24 hours and functional status was found in a recent individual participant data meta-analysis of the two largest trials, with improvements in functional recovery seen for blood pressure as low as 120–130 mm Hg. 83 These trials excluded patients with large and severe haematomas, however, so caution must be exercised when treating such patients, especially where large reductions in very hypertensive patients might predispose to harm.…”

Section: Acute Managementmentioning

confidence: 95%

Acute intracerebral haemorrhage: diagnosis and management

et al. 2020

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Intracerebral haemorrhage (ICH) accounts for half of the disability-adjusted life years lost due to stroke worldwide. Care pathways for acute stroke result in the rapid identification of ICH, but its acute management can prove challenging because no individual treatment has been shown definitively to improve its outcome. Nonetheless, acute stroke unit care improves outcome after ICH, patients benefit from interventions to prevent complications, acute blood pressure lowering appears safe and might have a modest benefit, and implementing a bundle of high-quality acute care is associated with a greater chance of survival. In this article, we address the important questions that neurologists face in the diagnosis and acute management of ICH, and focus on the supporting evidence and practical delivery for the main acute interventions.

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Section: Acute Managementmentioning

confidence: 95%

Acute intracerebral haemorrhage: diagnosis and management

et al. 2020

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“…Hypertensive cerebral haemorrhage accounts for 21 ~ 48% of all stroke patients, among which basal nucleus haemorrhage is the most common symptom, representing approximately 50% of cerebral haemorrhage patients [ 1 , 2 ]. Patients often have symptoms, such as hemianopia, hemiplegia and hemiparesthesia, because the conduction bundle in the basal ganglia is damaged [ 3 ]. If this condition not treated in time to relieve compression and protect nerve tissue, it will easily lead to limb nerve dysfunction, resulting in sequelae and affecting the prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the curative effect and prognosis of stereotactic drainage and conservative treatment for moderate and small basal ganglia haemorrhage

et al. 2021

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Background Minimally invasive surgery has achieved good results in the treatment of cerebral haemorrhage.However, no large-scale clinical study has demonstrated that surgical treatment of cerebral haemorrhages less than 30 ml can improve the curative effect. Our study explored the efficacy and complication of stereotactic drainage based on the amount of cerebral hemorrhage (15-30 ml) in hypertensive basal ganglia. Method Sixty patients with hypertensive basal ganglia haemorrhages were divided into a control group and an experimental group with 30 patients in each group. Patients in the control group were treated conservatively. In contrast, those in the experimental group received stereotactic drainage, and urokinase was injected into the haematoma cavity after the operation. The haematoma volume at admission and 1, 3, 7 and 30 days after treatment and National Institute of Health stroke scale(NIHSS) score data were recorded. Complications after treatment in the two groups of data were compared and analysed. Result No significant differences in age, sex, time of treatment after onset, admission blood pressure, admission haematoma volume or admission NIHSS score were noted between these two groups (P > 0.05). After treatment, significant differences in haematoma volume were noted between the two groups on the 1st, 3rd, 7th and 30th days after treatment (P < 0.05). The amount of hematoma of patients in the experimental group was significantly reduced compared with that in the control group, and the NIHSS scores were significantly different on the 3rd, 7th and 30th days after treatment. The neurological deficit scores of patients in the experimental group were significantly reduced compared with those in the control group, and the incidence of pulmonary infection and venous thrombosis in the lower limbs of patients in the experimental group were significantly reduced (P < 0.05). ROC curve analysis showed that stereotactic drainage affected the early neurological function of patients with small and medium basal ganglia haemorrhages. Conclusion For patients with small and medium basal ganglia haemorrhages, stereotactic drainage can be used due to the faster drainage speed of haematomas after operation, which is beneficial to the recovery of neurological function and reduce complications.

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“…Lastly, a recent systematic review of all randomized, controlled trials [ 111 ] evaluated the different effects of standard or intensive treatment of BP in patients with ICH. The primary outcomes were mortality at three months, disability based on a modified Rankin scale score, and the combination of death and disability.…”

Section: Resultsmentioning

confidence: 99%

Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

Cantone¹,

Lanza

Puglisi

et al. 2021

Brain Sciences

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Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.

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Effects of Intensive Blood Pressure Reduction on Acute Intracerebral Hemorrhage: A Systematic Review and Meta-analysis

Cited by 28 publications

References 36 publications

Acute intracerebral haemorrhage: diagnosis and management

Acute intracerebral haemorrhage: diagnosis and management

Comparison of the curative effect and prognosis of stereotactic drainage and conservative treatment for moderate and small basal ganglia haemorrhage

Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

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