Prognostic Value and Determinants of First-Day Mean Arterial Pressure in Spontaneous Supratentorial Intracerebral Hemorrhage

Fogelholm, R; Avikainen, Sari; Murros, Kari

doi:10.1161/01.str.28.7.1396

Cited by 185 publications

(108 citation statements)

References 21 publications

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“…4,5 The present results confirm this finding and show that although elevated BP is favoured by certain haematoma characteristics, it depends above all on preexisting factors. These included arterial hypertension and features of prior antihypertensive treatment.…”

supporting

confidence: 88%

“…[1][2][3][4][5][6][7][8] The underlying pathophysiological mechanism for this rise in BP is not clear and has generally been regarded as a direct and specific reaction to the vascular event itself, or has been associated with different factors such as Cushing response, stress of hospitalisation, autonomic nervous system damage, and history of hypertension. [3][4][5][6] Although these mechanisms may be operant, BP in stroke patients is probably the result of multifactorial interactions between pre-existing factors and specific aspects of the vascular event. Previous studies in patients with ICH 4,5 were mainly concerned with evaluating relations between BP and certain clinical and radiographic characteristics of the haemorrhage and ignored pre-existing factors that may determine BP.…”

mentioning

confidence: 99%

“…[3][4][5][6] Although these mechanisms may be operant, BP in stroke patients is probably the result of multifactorial interactions between pre-existing factors and specific aspects of the vascular event. Previous studies in patients with ICH 4,5 were mainly concerned with evaluating relations between BP and certain clinical and radiographic characteristics of the haemorrhage and ignored pre-existing factors that may determine BP. These factors may contribute heavily to the high BP observed at ICH onset, and in such cases the rise in BP may trigger bleeding rather than being an epiphenomenon.…”

mentioning

confidence: 99%

“…Volume of haematoma has been found to be a predictor of BP. 5 There is evidence that high BP is associated with a history of arterial hypertension, 5 but some authors failed to find such a relation. 4 An inverse relation between age and BP has been reported by some authors.…”

mentioning

confidence: 99%

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Blood pressure rise in spontaneous intracerebral haemorrhage: epiphenomenon or precipitating factor?

2003

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confidence: 88%

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confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Blood pressure rise in spontaneous intracerebral haemorrhage: epiphenomenon or precipitating factor?

2003

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“…We found similar myogenic responsive patterns in both in vivo and in vitro conditions that were clinically reminiscent of, first, adjusting high systemic blood pressure in patients after hemorrhagic stroke 14, 30. Interestingly, a recent clinical trial indicated that an acute reduction of systemic blood pressure did not significantly improve CBF to surrounding brain areas after hemorrhagic shock 31.…”

Section: Discussionsupporting

confidence: 58%

Extravascular Blood Augments Myogenic Constriction of Cerebral Arterioles: Implications for Hemorrhage‐Induced Vasospasm

Deng

Kandhi

Zhang

et al. 2018

JAHA

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BackgroundSubarachnoid hemorrhage is a serious clinical condition that impairs local cerebral blood flow perfusion and consequently initiates neuronal dysfunction. Pressure‐sensitive myogenic vasomotor regulation is an important mechanism involved in the regulation of cerebral blood flow. We hypothesized that extravascular hemolyzed blood enhances arteriolar myogenic constriction, which in vivo may contribute to the reduction of local cerebral blood flow after subarachnoid hemorrhage.Methods and ResultsArterioles isolated from the middle cerebral artery (MCA arterioles) of mice were cannulated in a perfusion chamber. Arteriolar diameters in response to step increases in intraluminal pressure (20–120 mm Hg) were measured in various experimental conditions. In response to increases in intraluminal pressure, all MCA arterioles exhibited myogenic vasoconstrictions. Compared with controls, the pressure‐induced constriction was significantly enhanced in arterioles (in vitro) exposed to extravascular hemolyzed blood or different concentrations of extracellular erythrocyte lysate (1%, 10%, and 20%) for different exposure durations (1–6 hours). The magnitude of enhancement was proportional to the lysate concentration and exposure duration. In in vivo experiments, 10 μL of autologous blood lysate were injected into the mouse subarachnoid space on the surface of the left MCA. Two hours later, MCA arterioles were isolated and left MCA arterioles displayed enhanced myogenic responses compared with the right MCA. The enhanced myogenic response was prevented by scavenge of superoxide in both in vitro and in vivo experiments.ConclusionsExtravascular hemolyzed blood, perhaps by promoting vascular production of superoxide, augments myogenic constriction of cerebral arterioles, which plays a crucial role in the subarachnoid hemorrhage–induced cerebral ischemia.

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Outcomes of Intensive Systolic Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Excessively High Initial Systolic Blood Pressure

et al. 2020

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IMPORTANCEThe safety and efficacy of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage who present with systolic blood pressure greater than 220 mm Hg appears to be unknown. OBJECTIVE To evaluate the differential outcomes of intensive (goal, 110-139 mm Hg) vs standard (goal, 140-179 mm Hg) systolic blood pressure reduction in patients with intracerebral hemorrhage and initial systolic blood pressure of 220 mm Hg or more vs less than 220 mm Hg. DESIGN, SETTING, AND PARTICIPANTSThis post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II trial was performed in November 2019 on data from the multicenter randomized clinical trial, which was conducted between May 2011 to September 2015. Patients with intracerebral hemorrhage and initial systolic blood pressure of 180 mm Hg or more, randomized within 4.5 hours after symptom onset, were included. INTERVENTIONS Intravenous nicardipine infusion titrated to goals.MAIN OUTCOMES AND MEASURES Neurological deterioration and hematoma expansion within 24 hours and death or severe disability at 90 days, plus kidney adverse events and serious adverse events until day 7 or hospital discharge.RESULTS A total of 8532 patients were screened, and 999 individuals (mean [SD] age, 62.0 [13.1] years; 620 men [62.0%]) underwent randomization and had an initial SBP value. Among 228 participants with initial systolic blood pressures of 220 mm Hg or more, the rate of neurological deterioration within 24 hours was higher in those who underwent intensive (vs standard) systolic blood pressure reduction (15.5% vs 6.8%; relative risk, 2.28 [95% CI, 1.03-5.07]; P = .04). The rate of death and severe disability (39.0% vs 38.4%; relative risk, 1.02 [95% CI, 0.73-1.78]; P = .92) was not significantly different between the 2 groups. There was a significantly higher rate of kidney adverse events in participants randomized to intensive systolic blood pressure reduction (13.6% vs 4.2%; relative risk, 3.22 [95% CI,]; P = .01), but no difference was observed in the rate of kidney serious adverse events. CONCLUSIONS AND RELEVANCEThe higher rate of neurological deterioration within 24 hours associated with intensive treatment in patients with intracerebral hemorrhage and initial systolic blood pressure of 220 mm Hg or more, without any benefit in reducing hematoma expansion at 24 hours or death or severe disability at 90 days, warrants caution against generalization of recommendations for intensive systolic blood pressure reduction.

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Prognostic Value and Determinants of First-Day Mean Arterial Pressure in Spontaneous Supratentorial Intracerebral Hemorrhage

Cited by 185 publications

References 21 publications

Blood pressure rise in spontaneous intracerebral haemorrhage: epiphenomenon or precipitating factor?

Blood pressure rise in spontaneous intracerebral haemorrhage: epiphenomenon or precipitating factor?

Extravascular Blood Augments Myogenic Constriction of Cerebral Arterioles: Implications for Hemorrhage‐Induced Vasospasm

Outcomes of Intensive Systolic Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Excessively High Initial Systolic Blood Pressure

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