Document Detail

Medical therapy for intracranial hemorrhage: Update Blood pressure management for prevention and acute treatment.
MedLine Citation:
PMID:  23196532     Owner:  NLM     Status:  In-Data-Review    
Intracerebral hemorrhage (ICH) is a common stroke subtype in Japan. Hypertension is the leading cause. Perindopril Protection Against Recurrent Stroke Study (PROGRESS) revealed that blood pressure (BP) lowering could reduce stroke recurrence by 28% (ICH recurrence by 49%). The guideline for the management of hypertension (JSH2009) recommends BP control of ≤140/90mmHg for patients with prior stroke. BP is frequently elevated in acute ICH, although BP management strategy is controversial. The guideline from the American Stroke Association suggests if systolic BP (SBP) >180mmHg and there is no evidence of elevated intracranial pressure, then consider a modest reduction of BP. A nationwide survey revealed that SBP lowering to ≤160mmHg using intravenous nicardipine in acute ICH is a major strategy in Japan, and the safety was confirmed by a multicenter, prospective, observational study. Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT) and Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) showed the feasibility and safety of early rapid BP lowering to 140mmHg. INTERACT2 and ATACH II are the randomized trials to compare the guideline-based control (<180mmHg) and strict control (<140mmHg). We have just started to enroll patients to ATACH II from Japan on February 2012.
Masatoshi Koga; Kazunori Toyoda
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Rinshō shinkeigaku = Clinical neurology     Volume:  52     ISSN:  1882-0654     ISO Abbreviation:  Rinsho Shinkeigaku     Publication Date:  2012  
Date Detail:
Created Date:  2012-11-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417466     Medline TA:  Rinsho Shinkeigaku     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1110-2     Citation Subset:  IM    
Division of Stroke Cave Unit, National Cerebral and Cardiovascular Center.
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