Intravenous Nicardipine Dosing for Blood Pressure Lowering in Acute Intracerebral Hemorrhage: The Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracerebral Hemorrhage Study

Blood glucose levels during the initial 72h and 3-month functional outcomes in acute intracerebral hemorrhage: The SAMURAI–ICH study

“…Twenty-two patients (12.5%) had diabetes mellitus. Median initial NIHSS score was 13 (interquartile range, [8][9][10][11][12][13][14][15][16][17]. Blood glucose levels on admission and at 24 h and 72 h were 134.8 ± 46.0 mg/dl, 135.9 ± 44.0 mg/dl, and 134.7 ± 45.7 mg/dl, respectively, and HbA1c level was 6.0 ± 1.1%.…”

“…The details have been documented previously [15][16][17][18]. Briefly, the following were the criteria for inclusion: age ≥ 20 years; total Glasgow Coma Scale (GCS) score ≥ 5; initial SBP N 180 mm Hg; computed tomography (CT) b 2.5 h after onset demonstrating a supratentorial intraparenchymal hematoma with manual volume measurement b 60 ml; and absence of extensive intraventricular hemorrhage.…”

“…Because some pilot studies have suggested that hyperglycemia directly contributes to secondary neurological injury [13,14], blood glucose changes after admission may have implications for developing therapeutic strategies. Because associations between blood glucose levels following admission and functional clinical outcomes have remained unclear, we investigated the effect of blood glucose levels within the initial 72 h on clinical outcomes using the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-ICH dataset [15].…”

Response to Letter Regarding Article, “Systolic Blood Pressure After Intravenous Antihypertensive Treatment and Clinical Outcomes in Hyperacute Intracerebral Hemorrhage: The Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study”

“…We calculated relative aSBP (%) using the formula [(initial SBP-mean aSBP)/initial SBP]×100 and assessed the relationship between relative aSBP and outcomes adopted in the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-Intracranial Hemorrhage (SAMURAI-ICH) study. 2 When using either 5% interval groups or quartile groups (relative aSBP >35%, 30%-35%, 25%-30%, and <25% or relative aSBP >36%, 32%-36%, 28%-32%, and <28%), frequencies of neurological deterioration, hematoma expansion, and unfavorable outcome in the lowest group (relative aSBP <25% or 28%) were generally high compared with those in the other groups. However, there were no remarkable differences in the frequencies among those either with relative aSBP >35%, 30% to 35%, and 25% to 30% or with relative aSBP >36%, 32% to 36%, and 28% to 32%.…”

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

“…However, the recently completed, main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) showed improved functional recovery without any harm from a more intensive strategy of BP lowering (target SBP, <140 mm Hg within 1 hour using intravenous agents) than contemporary guideline-recommended BP control (SBP, <180 mm Hg) in patients with ICH of mild to moderate severity and hypertension (SBP, 150-220 mm Hg). 17 Moreover, several smaller studies including the Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure (ICH-ADAPT) trial, 18 and observational studies in the first Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) study 14 and the Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study (SAMURAI-ICH Study), 19 have also demonstrated safety of intensive BP lowering in ICH. Despite this progress, there remains some uncertainty on the balance of safety and efficacy from larger reductions in SBP in ICH.…”