Tight Control of Systolic Blood Pressure in Spontaneous Intraparenchymal Brain Hemorrhage

Abstract

BackgroundTight blood pressure control is critical in neurosurgical patients. Systolic blood pressure (SBP) must be low enough to avoid injury and minimize intraparenchymal hemorrhage (IPH) but high enough to maintain cerebral perfusion. American Heart Association (AHA) guidelines recommend SBP <140 in intracerebral hemorrhage. This paper sought to elucidate the effect of early control of SBP on IPH expansion.Methods134 patients with spontaneous IPH between 2011 and 2015 were analyzed utilizing chart review. Initial versus follow-up bleed size, presentation and discharge condition, discharge disposition, and blood pressure control adequacy were analyzed using the generalized linear model.ResultsAltered mental status was the most common presenting complaint (78%). Presenting GCS failed to demonstrate a significant main effect. Age, initial IPH volume, presenting SBP, and one-hour SBP significantly affected IPH percent expansion (p=0.002, =0.002, <0.0005, and =0.026). Several two-way interactions affected IPH percent change implying synergistic effects of the predictor variables.ConclusionPatients aged 60-70 years had the largest percent IPH expansion followed by patients aged 20-30 years. Initial IPH volume of 65.23-78.26 ml showed the largest expansion. Initial IPH volume of 52.18-65.22 ml demonstrated the least percentage of IPH expansion. One-hour control of SBP to binned groups of 111-121 mmHg or 121-132 mmHg portends relative minima in bleed expansion corresponding with AHA recommendations for IPH patients. This study suggests that this degree of early and aggressive control of SBP is achievable, safe, and may minimize IPH expansion. Future studies are needed to elucidate the role of co-morbidities and to confirm these findings in broader populations.

Evaluation of risk factors for postoperative neurologic intensive care admission after brain tumor craniotomy: A single-center longitudinal study

“…For example, in intracerebral hemorrhagic stroke (ICH), there is an observed relationship between increased SBP with death and disability and an increased in-hospital mortality rate, with one study suggesting that early and aggressive control of SBP may minimize the expansion of hemorrhagic strokes. [ 23 ]…”

Safety and efficacy of continuous intravenous labetalol for blood pressure control in neurosurgical patients

“…7 Additionally, we classified patients who achieved the target BP within 1 hour into the early response group, and patients who achieved the target BP after 1 hour were classified into the late response group. 8,10…”

“…To assess the efficacy of labetalol in the study population, we defined the target BP as SBP ≤ 140 mmHg or DBP ≤ 90 mmHg based on our clinical practice along with previous clinical trials. 8,10 The guideline for the management of HT (the Eighth Joint National Committee guideline) was also taken into consideration when setting the BP target. 7 Additionally, we classified patients who achieved the target BP within 1 hour into the early response group, and patients who achieved the target BP after 1 hour were classified into the late response group.…”

“…7 Additionally, we classified patients who achieved the target BP within 1 hour into the early response group, and patients who achieved the target BP after 1 hour were classified into the late response group. 8,10 The primary efficacy outcome was assessed according to the number of earlyresponse patients. The secondary efficacy outcomes included the time required to achieve the target BP after labetalol administration and the BP change from baseline.…”

“…In our routine clinical practice, a BP goal of 140/90 mmHg is pursued to prevent intracranial complications, especially rebleeding. [7][8][9][10] The selection of antihypertensive agents is based on clinical conditions, comorbidities, and expert opinions.…”