Document Detail


Rapid blood pressure reduction in acute intracerebral hemorrhage: feasibility and safety.
MedLine Citation:
PMID:  18360781     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal blood pressure (BP) for treating acute intracerebral hemorrhage remains (ICH) uncertain. High BP may contribute to hematoma growth while excessive BP reduction might precipitate peri-hemorrhage ischemia. We examine here the feasibility and safety of reducing BP to lower than presently recommended levels in patients with acute ICH. METHODS: Patients with ICH were prospectively randomized to standard BP treatment (mean arterial BP [MAP] 110-130 mmHg) or aggressive BP lowering (MAP < 110 mmHg) within 8 h of symptom onset. MAP was managed during the 48 h treatment period. NIHSS was obtained at baseline, 24, and 48 h. Brain CT was done 24 h after symptoms. A modified Rankin Scale (mRs) was obtained at 90 days. A clinical decline (NIHSS drop > or = 2 points) within the first 48 h was the primary endpoint. Hematoma enlargement at 24 h was a secondary endpoint. RESULTS: We enrolled 21 patients into each group. Mean age was 60.6 +/- 12.3 years and MAP on presentation was 147.6 +/- 18.2 mmHg. Treatment was started on average 3.2 +/- 2.2 h after symptom onset. Baseline clinical variables were identical between the 2 treatment groups. Target blood pressure was achieved within 87.1 +/- 59.6 min in the standard group and 163.5 +/- 163.8 min in the aggressive BP treatment group. There were no significant differences in early neurological deterioration, hematoma and edema growth, and clinical outcome at 90 days. CONCLUSION: A more aggressive reduction of acute hypertension after ICH does not increase the rate of neurological deterioration even when treatment is initiated within hours of symptom onset. Lowering BP aggressively did not affect hematoma and edema expansion but this possibility deserves further study.
Authors:
Sebastian Koch; Jose G Romano; Alejandro M Forteza; Carolina Mejia Otero; Alejandro A Rabinstein
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Neurocritical care     Volume:  8     ISSN:  1541-6933     ISO Abbreviation:  Neurocrit Care     Publication Date:  2008  
Date Detail:
Created Date:  2008-05-15     Completed Date:  2008-09-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  316-21     Citation Subset:  IM    
Affiliation:
Department of Neurology, University of Miami Miller School of Medicine, 1150 NW 14th Street, Suite 609, Miami, FL 33136, USA. skoch@med.miami.edu
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Antihypertensive Agents / administration & dosage*,  adverse effects
Blood Pressure / drug effects
Brain Edema / drug therapy
Feasibility Studies
Female
Hematoma / drug therapy
Humans
Intracranial Hemorrhage, Hypertensive / drug therapy*
Labetalol / administration & dosage*,  adverse effects
Male
Middle Aged
Prospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 36894-69-6/Labetalol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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