The impact of hyperacute blood pressure lowering on the early clinical outcome following intracerebral hemorrhage.

OBJECTIVE: Blood pressure lowering in acute intracerebral hemorrhage patients may prevent hematoma growth and neurological deterioration. The optimal goal of hyperacute antihypertensive therapy for intracerebral hemorrhage patients to obtain a favorable early clinical outcome was investigated.

METHODS: Of 688 consecutive patients who were admitted to our stroke care units within 24 h after intracerebral hemorrhage onset, 244 patients who emergently received intravenous antihypertensive therapy due to admission blood pressure at least 180/105 mmHg were assessed. The average systolic and diastolic blood pressure values 6, 12, and 24 h after admission and the percentage reduction of the blood pressure value with respect to the admission blood pressure value were used for analysis.

RESULTS: At 3 weeks, 66 patients (27%) had a completely independent activity level corresponding to a modified Rankin Scale score of 1 or less. After adjustment for baseline characteristics, a favorable functional outcome was more common in patients with the lowest quartile of average systolic blood pressure in the initial 24 h (<138 mmHg, odds ratio 4.36, 95% confidence interval 1.10-17.22), and was similarly common in those with the middle two quartiles (138-148 mmHg, 148-158 mmHg) than in those with the highest quartile of systolic blood pressure (> or = 158 mmHg). Analyses using patient quartiles on the basis of the average diastolic blood pressure or the reduction of systolic or diastolic blood pressure did not show an association with early outcome.

CONCLUSION: Lowering the systolic blood pressure to less than 138 mmHg during the initial 24 h appears to be predictive of favorable early outcome in intracerebral hemorrhage patients. Randomized controlled trials to answer this question are needed.