Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage

Rodríguez‐Luna, David; Piñeiro, Socorro; Rubiera, Marta; Ribó, Marc; Coscojuela, Pilar; Pagola, Jorge; Flores, Alan; Muchada, Marián; Ibarra, B; Meler, Pilar; Sanjuan, Estela; Hernández-Guillamón, Mar; Alvarez-Sabin, José; Montaner, Joan; Molina, Carlos A.

doi:10.1111/ene.12180

Cited by 153 publications

(125 citation statements)

References 24 publications

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“…6,7 The similarities of the findings between the study by Rodriguez-Luna et al 6 and the present one were that SBP variability was predictive of early neurological deterioration but not predictive of hematoma expansion.…”

Section: Discussionsupporting

confidence: 74%

“…However, ours showed the positive association between SBP variability and absolute and relative changes in hematoma volume. Differences between the study by Rodriguez-Luna et al 6 and the present one were the baseline SBP level (mean, 172 versus 200 mm Hg), the proportion of patients receiving emergent AHT (43.6% versus 100%), and that the present one assessed the association of SBP variability with 3-month clinical outcomes, which was found to be significant. In the present study, not only vital outcome but also functional outcomes were assessed.…”

Section: The Similarities Between the Interact2contrasting

confidence: 69%

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Blood Pressure Variability on Antihypertensive Therapy in Acute Intracerebral Hemorrhage

Tanaka

Koga

Kobayashi

et al. 2014

Stroke

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E levated blood pressure (BP) is significantly associated with hematoma expansion, 1 neurological deterioration, 2 and unfavorable outcomes. 3 BP lowering with antihypertensive treatment (AHT) has been reported to be tolerated and feasible for acute patients with intracerebral hemorrhage (ICH). 4 The recent result of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2) demonstrated that BP lowering therapy with a target systolic level of <140 mm Hg tended to be beneficial for acute ICH. mm Hg were registered in a prospective, multicenter, observational study. All patients received antihypertensive therapy based on a predefined standardized protocol to lower and maintain SBP between 120 and 160 mm Hg using intravenous nicardipine. BPs were measured hourly during the initial 24 hours. BP variability was determined as SD and successive variation. The associations between BP variability and hematoma expansion (>33%), neurological deterioration within 72 hours, and unfavorable outcome (modified Rankin Scale, 4-6) at 3 months were assessed. Results-Of the 205 patients, 33 (16%) showed hematoma expansion, 14 (7%) showed neurological deterioration, and 81 (39%) had unfavorable outcomes. The SD and successive variation of SBP were 13.8 (interquartile range, 11.5-16.8) and 14.9 (11.7-17.7) mm Hg, respectively, and those of diastolic BP were 9.4 (7.5-11.2) and 13.1 (11.2-15.9) mm Hg, respectively. On multivariate regression analyses, neurological deterioration was associated with the SD of SBP (odds ratio, 2.75; 95% confidence interval, 1.45-6.12 per quartile) and the successive variation of SBP (2.37; 1.32-4.83), and unfavorable outcome was associated with successive variation of SBP (1.42; 1.04-1.97). Hematoma expansion was not associated with any BP variability. Conclusions-SBP

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Section: Discussionsupporting

confidence: 74%

Section: The Similarities Between the Interact2contrasting

confidence: 69%

Blood Pressure Variability on Antihypertensive Therapy in Acute Intracerebral Hemorrhage

Tanaka

Koga

Kobayashi

et al. 2014

Stroke

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“…Elevated blood pressure has been shown to be associated with the risk of hematoma expansion in patients with spontaneous intracerebral hemorrhage. [115][116][117] In patients with spontaneous intracerebral hemorrhage, studies showed the relative safety of intensive systolic blood pressure lowering to a goal of <140 mm Hg, e354…”

Section: -114mentioning

confidence: 99%

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Yaghi¹,

Willey²,

Cucchiara³

et al. 2017

Stroke

370

307

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Purpose— Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. Methods— A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH. The document sections were divided among writing group members who performed the literature review, summarized the literature, and provided suggestions on the diagnosis and treatment of patients with sICH caused by systemic thrombolysis with alteplase. Several drafts were circulated among writing group members until a consensus was achieved. Results— sICH is an uncommon but severe complication of systemic thrombolysis in acute ischemic stroke. Prompt diagnosis and early correction of the coagulopathy after alteplase have remained the mainstay of treatment. Further research is required to establish treatments aimed at maintaining integrity of the blood-brain barrier in acute ischemic stroke based on inhibition of the underlying biochemical processes.

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“…Mean SBP levels were significantly different between randomized groups from 15 minutes to day 7 post randomization; 150 mm Hg in the intensive group (462 [33%] achieved the target SBP) compared with 164 mm Hg in the guideline group (difference, 14 mm Hg; P<0.001) at 1 hour. Mean (SD)-achieved SBPs in the 1-to 24-hour and 2-to 7-day periods were 142 (13) mm Hg and 155 (14) mm Hg and 140 (11) mm Hg and 149 (13) mm Hg, in the intensive and guideline groups, respectively. 21 The primary outcome was death or major disability defined by the modified Rankin Scale (mRS), 22 and the secondary outcome was physical function across all 7 levels in an ordinal shift analysis of the mRS, 23 at 90 days post randomization.…”

Section: Methodsmentioning

confidence: 96%

“…Some studies have implied adverse effects from reducing systolic BP (SBP), [8][9][10] whereas others have indicated clinical improvement with higher SBP reduction [11][12][13][14] or no benefits at all of such treatment in ICH. 15 An important meta-regression analysis of randomized controlled trials of altered BP in acute stroke showed a J-shaped relationship, with the best outcomes from modest SBP reduction (<10 mm Hg), but the number of patients included with ICH was limited.…”

mentioning

confidence: 99%

Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage

et al. 2015

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Abstract-Evidence supports early intensive blood pressure (BP) lowering in acute intracerebral hemorrhage, but uncertainty persists over whether potential benefits and harms vary according to the magnitude of BP reduction. We aimed to determine whether larger systolic BP (SBP) reductions were associated with better outcomes in participants of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). INTERACT2 was an international, open, blinded end point, randomized controlled trial of patients with spontaneous intracerebral hemorrhage (<6 hours) and elevated SBP (150-220 mm Hg) assigned to intensive (target SBP <140 mm Hg) or guideline-recommended (SBP <180 mm Hg) treatment. Associations of BP reduction (baseline minus average of achieved SBP) during 3 time periods post randomization (15-60 minutes, 1-24 hours, and 2-7 days) on poor outcome (death or major disability) at 90 days were analyzed in multivariable logistic regression models with odds ratios and 95% confidence intervals. Larger SBP reductions within the first hour after randomization were associated with lower risks of poor outcome: compared with minimal reduction (<10 mm Hg), odds ratios were 0.80 (95% confidence interval, 0.63-1.02) for moderate (10-20 mm Hg) and 0.65 (0.52-0.82) for large (≥20 mm Hg) reductions (P trend <0.01). Similar associations were also observed for SBP reductions during 1 to 24 hours (P<0.01) and 2 to 7 days (P 0.02). No heterogeneity in associations for patients above or below baseline SBP 180 mm Hg was reported (P>0.30). Optimal recovery from intracerebral hemorrhage was observed in hypertensive patients who achieved the greatest SBP reductions (≥20 mm Hg) in the first hour and maintained for 7 days. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.

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Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage

Abstract: In patients with acute supratentorial ICH, SBP 180-load independently predicts HG, whilst both SBP 180-load and SBP variability predict END.

Cited by 153 publications

References 24 publications

Blood Pressure Variability on Antihypertensive Therapy in Acute Intracerebral Hemorrhage

Blood Pressure Variability on Antihypertensive Therapy in Acute Intracerebral Hemorrhage

Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Magnitude of Blood Pressure Reduction and Clinical Outcomes in Acute Intracerebral Hemorrhage

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