Involvement of Fluctuating High Blood Pressure in the Enlargement of Spontaneous Intracerebral Hematoma

Abstract

The correlations between changes in blood pressure after admission and hematoma expansion were in vestigated in 118 patients with spontaneous intracerebral hematoma admitted within 24 hours of onset who underwent serial computed tomography. Multiple logistic regression was performed to assess cor relations between hematoma enlargement and clinical characteristics on admission. Hematoma en largement was predominantly correlated with time of onset (p 0.01567), and not well correlated with blood pressure at admission (p 0.07908). Serial changes in blood pressure were investigated in 57 patients admitted within 6 hours of ictus whose blood pressures were monitored every hour from admission. Wilcoxon signedrank analysis was used to determine the relationships between hematoma enlargement and blood pressure. Patients with hematoma enlargement was significantly correlated with increased blood pressure (p 0.0004). Increases in blood pressure after admission may be a factor in hematoma enlargement.

Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hemorrhage

“…5,22 Higher heart rate might reflect patient distress and could be associated with other parameters such as higher and unstable blood pressure that have been reported to be related to hematoma growth during the clinical course. 23,24 In contrast to the main analyses, our subgroup analyses of patients with available 24-hour CT data (both with and without adjustment for hematoma growth) showed nonsignificant association between heart rate and 90-day mRS score. This is likely because of decreased statistical power of the subgroup analyses as the patient population was decreased by almost a half in comparison with the main analyses.…”

Effect of Treatment of Elevated Blood Pressure on Neurological Deterioration in Patients with Acute Intracerebral Hemorrhage

“…Previous studies have associated high blood pressure with hematoma enlargement [3][4][5][6][7]. In the INTERACT pilot trial, the rate of substantial growth was reduced in patients whose blood pressure was more aggressively lowered (P = 0.05).…”

“…The treatment of acute hypertension in patients with ICH is highly controversial [2]. There is concern for perihematomal ischemia with reduction of blood pressure (BP) [2] and persistently elevated BP may increase the risk of hematoma expansion after acute ICH [3][4][5][6][7]. No Phase III clinical trials have studied the differential safety or efficacy of treatment strategies for elevated blood pressure in acute ICH.…”

Efficacy of the American Heart Association/American Stroke Association guidelines for ultra-early, intentional antihypertensive therapy in intracerebral hemorrhage

“…Previous studies reported several features that predict HE, including a shorter time from onset to hospitalization, consciousness disturbance, previous cerebral infarction, liver dysfunction, excessive alcohol consumption, coagulation abnormalities, hyperglycemia, irregularly shaped hematoma, heterogeneity of hematoma and some hemodynamic parameters. [1][2][3]6,7,[15][16][17][18] Among these, we consider irregularly shaped hematoma and heterogeneity of hematoma not as a causal factors, but as danger signs of HE. These variables were not included in our statistical analysis regarding prediction of HE risk.…”

“…[1][2][3]5 Several studies have demonstrated a causal link between a higher blood pressure (BP) in the acute settings and subsequent HE. 3,6,7 However, whether attempting to decrease BP during the acute phase provides therapeutic benefit by preventing subsequent HE remains contentious. [7][8][9][10] The American Heart Association's (AHA) guidelines for management of spontaneous ICH were published in 1999, in which a special group of the Stroke Council of the AHA recommended that BP should be lowered to below a mean arterial pressure (MAP) of 130 mm Hg if the systolic blood pressure (SBP) was P180 mm Hg, the diastolic blood pressure (DBP) was P105 mm Hg or the MAP was P130 mm Hg.…”