Rapid BP Lowering Safe in Intracerebral Hemorrhage

Rapid blood pressure (BP) lowering in patients with intracerebral hemorrhage (ICH) is safe and does not compromise cerebral blood flow (CBF), according to a new study.

Researchers at the University of Alberta (Edmonton, Canada) conducted a study involving 75 patients with spontaneous ICH, who were randomly assigned to an intravenous antihypertensive treatment protocol targeting a systolic BP of less than 150 mm Hg (aggressive treatment) or less than 180 mm Hg (conservative treatment). The treatment groups were balanced with respect to baseline demographics, systolic BP, and hematoma volume, and underwent computerized tomography (CT) perfusion imaging two hours postrandomization. The primary endpoint was relative CBF within the one cm perihematoma region.

The results showed that within 30 minutes of randomization, mean systolic BP was significantly lower in the patients in the aggressive treatment group. Target BP was achieved in 79% of patients in the aggressive treatment group, and in 100% of those receiving conservative treatment. The CT perfusion imaging scans demonstrated that blood flow around the hematoma was not significantly different in the 39 patients assigned to an aggressive intravenous antihypertensive treatment protocol, when compared with the 36 patients conservatively treated. The study was published ahead of print on February 7, 2013, in Stroke.

“Our results suggest that a more aggressive absolute target of less than 150 mm Hg did not reduce cerebral blood flow, relative to conservatively managed patients, even when treatment was initiated earlier and in those with larger hematoma volumes,” concluded lead author Kenneth Butcher, MD, PhD, and colleagues. “We also found no consistent relationship between the magnitude of the blood pressure drop and perihematoma cerebral blood flow.”

Spontaneous ICH is one of the most serious pathological subtypes of stroke, which accounts for about 10% of strokes in Caucasian populations and between 20% and 50% of strokes in other ethnic groups, and has a 30-day case fatality of 20%–40%. BP is commonly elevated after ICH, and is either a marker or contributor to active hematoma growth within the first few hours after onset. The goal of the BP lowering in ICH is to reduce or even tapenade ongoing bleeding and reduce the size of the hematoma in the brain.

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