Response to Letter Regarding Article, “Systolic Blood Pressure After Intravenous Antihypertensive Treatment and Clinical Outcomes in Hyperacute Intracerebral Hemorrhage: The Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study”

Abstract

We thank Dr Aries and his colleagues for their interest in our article and their valuable suggestions on this topic. As we know, in our study, higher mean achieved systolic blood pressure (mean aSBP) was associated with neurological deterioration (multivariableadjusted odds ratio, 4.43; 95% confidence interval, 1.98-9.90 for every 10-mm Hg increment of mean aSBP), hematoma expansion (odds ratio, 1.80; 95% confidence interval, 1.08-2.98), and unfavorable outcome (odds ratio, 2.00; 95% confidence interval, 1.23-3.26). 1We used the absolute indicator (mean aSBP), but we agree that relative indicator is also interesting and important in terms of individualized antihypertensive treatment in hyperacute intracerebral hemorrhage. We calculated relative aSBP (%) using the formula [(initial SBP-mean aSBP)/initial SBP]×100 and assessed the relationship between relative aSBP and outcomes adopted in the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracranial Hemorrhage (SAMURAI-ICH) study. 2When using either 5% interval groups or quartile groups (relative aSBP >35%, 30%-35%, 25%-30%, and <25% or relative aSBP >36%, 32%-36%, 28%-32%, and <28%), frequencies of neurological deterioration, hematoma expansion, and unfavorable outcome in the lowest group (relative aSBP <25% or 28%) were generally high compared with those in the other groups. However, there were no remarkable differences in the frequencies among those either with relative aSBP >35%, 30% to 35%, and 25% to 30% or with relative aSBP >36%, 32% to 36%, and 28% to 32%. Therefore, there seemed to be no U-shaped phenomenon of the relationship between changes in blood pressure and outcomes reported in previous studies. [3][4][5] We are now preparing a manuscript with detailed results. From these observations, our data did not support that there was a U-shaped phenomenon between relative SBP decrement and clinical and radiological outcomes, and we may need to lower SBP ≥25% (or 28%) in hyperacute intracerebral hemorrhage patients with markedly elevated SBP (>180 mm Hg) on admission. DisclosuresNone.

Optimal achieved blood pressure in acute intracerebral hemorrhage

“…7,12,13 However, a few studies propose a J-shaped association, whereby increased mortality was observed for both the highest and lowest SBP. 9,11 A hospital-based study from Greece reported a modest increase in 1-year mortality among patients with admission SBP #140 mm Hg compared to those with 141-161 mm Hg.…”

Relative systolic blood pressure reduction and clinical outcomes in hyperacute intracerebral hemorrhage

“…A total of 211 patients [81 women, median age 65 (interquartile range 58-74) years, and median initial NIHSS score 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)] were included in the SAMURAI-ICH study [15]. Table 1 shows the clinical background characteristics of the included patients.…”

“…The details of the study have been described elsewhere [15,16]. Briefly, acute spontaneous supratentorial ICH patients with hypertension (initial SBP >180 mmHg) who were treated within 3 h from onset in 10 Japanese stroke centers were enrolled.…”

Acute Blood Pressure Management in Neurocritically Ill Patients

“…Elevated BP in patients with ICH was associated with poor outcomes including hematoma expansion, perihematoma edema, worse functional outcomes, and death …”