Rapid Blood Pressure Reduction in Acute Intracerebral Hemorrhage: Feasibility and Safety

Koch, Sebastian; Romano, José G.; Forteza, Alejandro M.; Otero, Carolina Mejia; Rabinstein, Alejandro A.

doi:10.1007/s12028-008-9085-8

Cited by 64 publications

(49 citation statements)

References 31 publications

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“…Although only 50% of our patients achieved a target MAP of 100 -110 mm Hg using our pre-specified goal of 120 min, over 90% of our patients reached this goal with an additional 80 min of therapy. A prior study by Koch et al has shown that the MAP can be safely lowered to a level of Ͻ 110 mm Hg in patients with spontaneous ICH (20). The average time to target MAP in our study compares favorably to this study (123 min Ϯ 73 min compared to 163 min Ϯ 164 min in the Koch et al study) (20).…”

Section: Discussionsupporting

confidence: 66%

Emergency Department Control of Blood Pressure in Intracerebral Hemorrhage

Honner

Singh

Cheung

et al. 2011

The Journal of Emergency Medicine

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Section: Discussionsupporting

confidence: 66%

Emergency Department Control of Blood Pressure in Intracerebral Hemorrhage

Honner

Singh

Cheung

et al. 2011

The Journal of Emergency Medicine

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“…Details of the studies and participants are given in Table 1 and online supplementary Table e-1, respectively. All trials used adequate methods of sequence generation and allocation concealment except one [7]. All studies were rated as high risk of performance and low risk of detection, attrition, and reporting bias (online suppl.…”

Section: Resultsmentioning

confidence: 99%

How Should We Lower Blood Pressure after Cerebral Hemorrhage? A Systematic Review and Meta-Analysis

Lattanzi¹,

Cagnetti²,

Provinciali³

et al. 2017

Cerebrovasc Dis

104

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Background: The optimal treatment of high blood pressure (BP) after acute intra-cerebral hemorrhage (ICH) is controversial. Summary: The aim of the study was to evaluate the safety and efficacy of early intensive vs. conservative BP lowering treatment in patients with ICH. Randomized controlled trials with active and control groups receiving intensive and conservative BP lowering treatments were identified. The following outcomes were assessed: 3-month mortality and combined death or major disability, 24-h hematoma growth, early neurological deterioration, occurrence of hypotension, severe hypotension, and serious treatment-emergent adverse events. Five trials were included involving 4,350 participants, 2,162 and 2,188 for intensive and conservative treatment groups, respectively. The pooled risk ratio of 3-month death or major disability was 0.96 (0.91-1.01) and the weighted mean difference in absolute hematoma growth was -1.53 (95% CI -2.94 to -0.12) mL in the intensive compared to conservative BP-lowering. There were no differences across the treatments in the incidence rates of 3-month mortality, early neurological deterioration, hypotension, and treatment-related adverse effects other than renal events. Key Messages: The early intensive anti-hypertensive treatment was overall safe and reduced the hematoma expansion in patients presenting with acute-onset spontaneous ICH and high BP levels.

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“…3,4 Several recent trials have sought to determine whether intensive lowering of BP acutely improves outcomes in patients with ICH. [5][6][7][8][9][10] Over the last several years, a growing number of studies have characterized the presence and frequency of ischemic lesions remote from the acute hematoma visualized on diffusion-weighted imaging (DWI) in patients with primary ICH undergoing MRI. [11][12][13][14][15][16][17][18][19] Across these series, remote DWI lesions are visualized in 11%-41% of patients.…”

mentioning

confidence: 99%

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

et al. 2017

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Objective: To evaluate the associations among diffusion-weighted imaging (DWI) lesions, blood pressure (BP) dysregulation, MRI markers of small vessel disease, and poor outcome in a large, prospective study of primary intracerebral hemorrhage (ICH). Methods:The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a multicenter, observational study of ICH among white, black, and Hispanic patients.Results: Of 600 patients, mean (6SD) age was 60.8 6 13.6 years, median (interquartile range) ICH volume was 9.1 mL (3.5-20.8), and 79.6% had hypertension. Overall, 26.5% of cases had DWI lesions, and this frequency differed by race/ethnicity (black 33.8%, Hispanic 24.9%, white 20.2%, overall p 5 0.006). A logistic regression model of variables associated with DWI lesions included lower age (odds ratio [OR] 0.721, p 5 0.002), higher first recorded systolic BP (10-unit OR 1.12, p 5 0.002), greater change in mean arterial pressure (MAP) prior to the MRI (10-unit OR 1.10, p 5 0.037), microbleeds (OR 1.99, p 5 0.008), and higher white matter hyperintensity (WMH) score (1-unit OR 1.16, p 5 0.002) after controlling for race/ethnicity, leukocyte count, and acute in-hospital antihypertensive treatment. A second model of variables associated with poor 90-day functional outcome (modified Rankin Scale scores 4-6) included DWI lesion count (OR 1.085, p 5 0.034) as well as age, ICH volume, intraventricular hemorrhage, Glasgow Coma Scale score, WMH score, race/ethnicity, acute in-hospital antihypertensive treatment, and ICH location. Conclusions:These results support the hypotheses that acute BP dysregulation is associated with the development of DWI lesions in primary ICH and that DWI lesions are, in turn, associated with poor outcomes. Neurology ® 2017;88:782-788 GLOSSARY ADC 5 apparent diffusion coefficient; BP 5 blood pressure; CAA 5 cerebral amyloid angiopathy; DWI 5 diffusion-weighted imaging; ERICH 5 Ethnic/Racial Variations of Intracerebral Hemorrhage; FLAIR 5 fluid-attenuated inversion recovery; GCS 5 Glasgow Coma Scale; GRE 5 gradient recalled echo; ICH 5 intracerebral hemorrhage; INTERACT2 5 Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage 2; IVH 5 intraventricular hemorrhage; MAP 5 mean arterial pressure; mRS 5 modified Rankin Scale; SBP 5 systolic blood pressure; SWI 5 susceptibility-weighted imaging; WMH 5 white matter hyperintensity.Primary intracerebral hemorrhage (ICH) is the second most common cause of stroke, affecting over 1 million people worldwide each year.1,2 ICH causes significantly greater morbidity and mortality than ischemic stroke. Hypertension is the most common risk factor for ICH. Elevated blood pressure (BP), often at extreme levels, frequently occurs in the hyperacute and acute phases of primary ICH and is associated with hemorrhage expansion and poor outcome. 3,4 Several recent trials have sought to determine whether intensive lowering of BP acutely improves outcomes in patients with ICH. 5-10Over the last several years, a growing number of studies have characte...

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Rapid Blood Pressure Reduction in Acute Intracerebral Hemorrhage: Feasibility and Safety

Cited by 64 publications

References 31 publications

Emergency Department Control of Blood Pressure in Intracerebral Hemorrhage

Emergency Department Control of Blood Pressure in Intracerebral Hemorrhage

How Should We Lower Blood Pressure after Cerebral Hemorrhage? A Systematic Review and Meta-Analysis

Ischemic lesions, blood pressure dysregulation, and poor outcomes in intracerebral hemorrhage

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