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Continuous antihypertensive therapy throughout the initial 24 hours of intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study

Junpei Kobayashi, Masatoshi Koga, Eijirou Tanaka, Yasushi Okada, Kazumi Kimura, Hiroshi Yamagami, Satoshi Okuda, Yasuhiro Hasegawa, Yoshiaki Shiokawa, Eisuke Furui, Jyoji Nakagawara, Kazuomi Kario, Takuya Okata, Shoji Arihiro, Shoichiro Sato, Kazuyuki Nagatsuka, Kazuo Minematsu, Kazunori Toyoda
Stroke; a Journal of Cerebral Circulation 2014, 45 (3): 868-70
24425118

BACKGROUND AND PURPOSE: A short duration (<24 hours) of antihypertensive therapy (AHT) after acute intracerebral hemorrhage (ICH) may be sufficient because active bleeding generally ceases within several hours. We aimed to determine the association between sequential systolic blood pressure (SBP) levels during AHT and outcomes in ICH patients.

METHODS: In 211 hyperacute ICH patients who underwent AHT based on predefined protocol, the mean of hourly SBP (mSBP) measurements was calculated over 1 to 8 hours (first mSBP), 9 to 16 hours (second mSBP), and 17 to 24 hours (third mSBP) after the initiation of AHT. Outcomes included neurological deterioration (72-hour Glasgow Coma Scale decrease ≥2 or National Instititutes of Health Stroke Scale increase ≥4), hematoma expansion (>33%), and unfavorable outcome (3-month modified Rankin Scale score 4-6).

RESULTS: The median first, second, and third mSBPs were 132, 131, and 137 mm Hg, respectively. A higher first mSBP (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.34-4.69 per 10 mm Hg) or second mSBP (OR, 2.08; 95% CI, 1.20-3.80) was independently associated with neurological deterioration, and a higher second mSBP (OR, 1.40; 95% CI, 1.02-2.00) or third mSBP (OR, 1.45; 95% CI, 1.05-2.05) was associated with unfavorable outcome. None of the mSBPs was associated with hematoma expansion.

CONCLUSIONS: The continuation of AHT throughout the initial 24 hours after ICH may improve outcomes.

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