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Rapid Blood-Pressure Lowering in Patients With Acute Intracerebral Hemorrhage
Study Questions:
What is the impact of rapid lowering of blood pressure in patients with intracerebral hemorrhage?
Methods:
The authors randomized 2,839 patients with intracerebral hemorrhage and elevated blood pressure to rapid lowering of blood pressure to a target systolic blood pressure of <140 mm Hg or usual therapy, with control of blood pressure to <180 mm Hg. The primary endpoint was death or major disability.
Results:
There was a trend toward a reduction in the primary endpoint with rapid lowering of blood pressure (52% vs. 55.6%, p = 0.06) with no difference in mortality (11.9% vs. 12%). There was a reduction in major disability based on an ordinal analysis of the Rankin scale (odds ratio, 0.87; 95% confidence interval, 0.77-0.1; p = 0.04). There was no difference in major adverse events between the two groups (23.3% vs. 23.6%).
Conclusions:
Among patients with an intracerebral hemorrhage and an elevated blood pressure, rapid lowering of blood pressure is safe and associated with a trend toward reduction in disability.
Perspective:
Intracerebral hemorrhage has a high mortality, and those who survive the initial insult have significant residual disability. This study suggests that rapid control of blood pressure may slightly improve disability, with no difference in mortality or an increase in side effects. Nevertheless, it may be premature to switch clinical practice completely, and it would be preferable to await the results of the ongoing ATACH II trial that is testing nicardipine for lowering blood pressure in patients with intracerebral hemorrhage.
Keywords: Disabled Persons, Nicardipine, Hypotension, Blood Pressure, Cerebral Hemorrhage
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