Download PDF
Semin Neurol 2016; 36(03): 269-273
DOI: 10.1055/s-0036-1583264
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Blood Pressure Management in Intracerebral Hemorrhage

Yousef Mohammad
1   Division of Neurology, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
,
Adnan Qureshi
2   Department of Neurology, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
23 May 2016 (online)

    Permissions and Reprints

Abstract

Intracerebral hemorrhage (ICH) is associated with devastating outcomes. Admission to the intensive care unit has been the only proven course to improve outcomes. All other treatment modalities have failed so far. The majority of patients presenting with ICH have an elevated blood pressure (BP). Initial data on the safety and efficacy of BP treatment in acute ICH have been conflicting. This has led to large prospective and randomized clinical trials to assess the safety and efficacy of early BP lowering in acute ICH. These trials showed safety and a tendency toward improved functional outcomes. In fact, the results of three subsequent meta-analyses also showed safety and possible efficacy of early lowering of BP in ICH. Based on the results of the published clinical trials and meta-analyses, the American Heart Association and the European Stroke Association concluded that early intensive treatment of BP in acute ICH is safe and might improve functional outcome. The authors advocate that—pending additional data from ongoing trials—health care professionals should maintain the SBp < 140 mm Hg in patients presenting with acute ICH.

Keywords

intracerebral hemorrhage - blood pressure - hematoma - cerebral blood flow
 

  • References

  • 1 Santalucia P. Intracerebral hemorrhage: medical treatment. Neurol Sci 2008; 29 (Suppl. 02) S271-S273
    PubMedGoogle Scholar
  • 2 Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage. Lancet 2009; 373 (9675) 1632-1644
    CrossrefPubMedGoogle Scholar
  • 3 Vuylsteke A, Vincent JL, de La Garanderie DP , et al; Euro-STAT Investigators. Characteristics, practice patterns, and outcomes in patients with acute hypertension: European Registry for Studying the Treatment of Acute Hypertension (Euro-STAT). Crit Care 2011; 15 (6) R271
    CrossrefPubMedGoogle Scholar
  • 4 Mayer SA, Brun NC, Begtrup K , et al; Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2005; 352 (8) 777-785
    CrossrefPubMedGoogle Scholar
  • 5 Brouwers HB, Goldstein JN. Therapeutic strategies in acute intracerebral hemorrhage. Neurotherapeutics 2012; 9 (1) 87-98
    CrossrefPubMedGoogle Scholar
  • 6 van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9 (2) 167-176
    CrossrefPubMedGoogle Scholar
  • 7 Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med 2001; 344 (19) 1450-1460
    CrossrefPubMedGoogle Scholar
  • 8 Qureshi AI, Ezzeddine MA, Nasar A , et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med 2007; 25 (1) 32-38
    CrossrefPubMedGoogle Scholar
  • 9 Balci K, Utku U, Asil T , et al. The effect of admission blood pressure on the prognosis of patients with intracerebral hemorrhage that occurred during treatment with aspirin, warfarin, or no drugs. Clin Exp Hypertens 2012; 34 (2) 118-124
    CrossrefPubMedGoogle Scholar
  • 10 Terayama Y, Tanahashi N, Fukuuchi Y, Gotoh F. Prognostic value of admission blood pressure in patients with intracerebral hemorrhage. Keio Cooperative Stroke Study. Stroke 1997; 28 (6) 1185-1188
    CrossrefPubMedGoogle Scholar
  • 11 Vemmos KN, Tsivgoulis G, Spengos K , et al. U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med 2004; 255 (2) 257-265
    CrossrefPubMedGoogle Scholar
  • 12 Leonardi-Bee J, Bath PM, Phillips SJ, Sandercock PA ; IST Collaborative Group. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 2002; 33 (5) 1315-1320
    CrossrefPubMedGoogle Scholar
  • 13 Brott T, Broderick J, Kothari R , et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 14 Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke 1996; 27 (10) 1783-1787
    CrossrefPubMedGoogle Scholar
  • 15 Qureshi AI, Mohammad YM, Yahia AM , et al. A prospective multicenter study to evaluate the feasibility and safety of aggressive antihypertensive treatment in patients with acute intracerebral hemorrhage. J Intensive Care Med 2005; 20 (1) 34-42
    CrossrefPubMedGoogle Scholar
  • 16 Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Tanaka R. Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage. Stroke 1998; 29 (6) 1160-1166
    CrossrefPubMedGoogle Scholar
  • 17 Davis SM, Broderick J, Hennerici M , et al; Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 2006; 66 (8) 1175-1181
    CrossrefPubMedGoogle Scholar
  • 18 Delcourt C, Huang Y, Arima H , et al; INTERACT1 Investigators. Hematoma growth and outcomes in intracerebral hemorrhage: the INTERACT1 study. Neurology 2012; 79 (4) 314-319
    CrossrefPubMedGoogle Scholar
  • 19 Carlberg B, Asplund K, Hägg E. The prognostic value of admission blood pressure in patients with acute stroke. Stroke 1993; 24 (9) 1372-1375
    CrossrefPubMedGoogle Scholar
  • 20 Chen ST, Chen SD, Hsu CY, Hogan EL. Progression of hypertensive intracerebral hemorrhage. Neurology 1989; 39 (11) 1509-1514
    CrossrefPubMedGoogle Scholar
  • 21 Broderick JP, Brott TG, Tomsick T, Barsan W, Spilker J. Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg 1990; 72 (2) 195-199
    CrossrefPubMedGoogle Scholar
  • 22 Maruishi M, Shima T, Okada Y, Nishida M, Yamane K. Involvement of fluctuating high blood pressure in the enlargement of spontaneous intracerebral hematoma. Neurol Med Chir (Tokyo) 2001; 41 (6) 300-304 , discussion 304–305
    CrossrefPubMedGoogle Scholar
  • 23 Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke 2004; 35 (6) 1364-1367
    CrossrefPubMedGoogle Scholar
  • 24 Nath FP, Kelly PT, Jenkins A, Mendelow AD, Graham DI, Teasdale GM. Effects of experimental intracerebral hemorrhage on blood flow, capillary permeability, and histochemistry. J Neurosurg 1987; 66 (4) 555-562
    CrossrefPubMedGoogle Scholar
  • 25 Bullock R, Brock-Utne J, van Dellen J, Blake G. Intracerebral hemorrhage in a primate model: effect on regional cerebral blood flow. Surg Neurol 1988; 29 (2) 101-107
    CrossrefPubMedGoogle Scholar
  • 26 Qureshi AI, Wilson DA, Hanley DF, Traystman RJ. No evidence for an ischemic penumbra in massive experimental intracerebral hemorrhage. Neurology 1999; 52 (2) 266-272
    CrossrefPubMedGoogle Scholar
  • 27 Zazulia AR, Diringer MN, Videen TO , et al. Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab 2001; 21 (7) 804-810
    PubMedGoogle Scholar
  • 28 Kate MP, Hansen MB, Mouridsen K , et al; ICHADAPT Investigators. Blood pressure reduction does not reduce perihematoma oxygenation: a CT perfusion study. J Cereb Blood Flow Metab 2014; 34 (1) 81-86
    CrossrefPubMedGoogle Scholar
  • 29 Gould B, McCourt R, Asdaghi N , et al; ICH ADAPT investigators. Autoregulation of cerebral blood flow is preserved in primary intracerebral hemorrhage. Stroke 2013; 44 (6) 1726-1728
    CrossrefPubMedGoogle Scholar
  • 30 Tamm AS, McCourt R, Gould B , et al; ICH ADAPT Investigators. Cerebral perfusion pressure is maintained in acute intracerebral hemorrhage: a CT perfusion study. AJNR Am J Neuroradiol 2016; 37 (2) 244-251
    CrossrefPubMedGoogle Scholar
  • 31 Butcher KS, Jeerakathil T, Hill M , et al; ICH ADAPT Investigators. The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial. Stroke 2013; 44 (3) 620-626
    CrossrefPubMedGoogle Scholar
  • 32 Worster A, Keim SM, Carpenter CR, Adeoye O ; Best Evidence in Emergency Medicine (BEEM) Group. Does early intensive lowering of blood pressure reduce hematoma volume and improve clinical outcome after acute cerebral hemorrhage?. J Emerg Med 2009; 37 (4) 433-438
    CrossrefPubMedGoogle Scholar
  • 33 Broderick JP, Adams Jr HP, Barsan W , et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1999; 30 (4) 905-915
    CrossrefPubMedGoogle Scholar
  • 34 Nishikawa T, Ueba T, Kajiwara M, Iwata R, Miyamatsu N, Yamashita K. Preventive effect of aggressive blood pressure lowering on hematoma enlargement in patients with ultra-acute intracerebral hemorrhage. Neurol Med Chir (Tokyo) 2010; 50 (11) 966-971
    CrossrefPubMedGoogle Scholar
  • 35 Suri MF, Suarez JI, Rodrigue TC , et al. Effect of treatment of elevated blood pressure on neurological deterioration in patients with acute intracerebral hemorrhage. Neurocrit Care 2008; 9 (2) 177-182
    CrossrefPubMedGoogle Scholar
  • 36 Kobayashi J, Koga M, Tanaka E , et al; SAMURAI Study Investigators. Continuous antihypertensive therapy throughout the initial 24 hours of intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. Stroke 2014; 45 (3) 868-870
    CrossrefPubMedGoogle Scholar
  • 37 Sakamoto Y, Koga M, Todo K , et al; SAMURAI Study Investigators. Relative systolic blood pressure reduction and clinical outcomes in hyperacute intracerebral hemorrhage: the SAMURAI-ICH observational study. J Hypertens 2015; 33 (5) 1069-1073
    CrossrefPubMedGoogle Scholar
  • 38 Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral haemorrhage: low blood pressure and early neurological deterioration. Br J Neurosurg 2010; 24 (4) 410-414
    CrossrefPubMedGoogle Scholar
  • 39 Burke RE, Dorfman M, Chan SB. Is emergent anti-hypertensive treatment beneficial in intracranial hemorrhage?. J Emerg Med 2005; 29 (1) 9-13
    CrossrefPubMedGoogle Scholar
  • 40 Hwang SK, Kim JS, Kim JH, Hong CK, Yang KH. Antihypertensive treatment of acute intracerebral hemorrhage by intravenous nicardipine hydrochloride: prospective multi-center study. J Korean Med Sci 2012; 27 (9) 1085-1090
    CrossrefPubMedGoogle Scholar
  • 41 Qureshi AI, Bliwise DL, Bliwise NG, Akbar MS, Uzen G, Frankel MR. Rate of 24-hour blood pressure decline and mortality after spontaneous intracerebral hemorrhage: a retrospective analysis with a random effects regression model. Crit Care Med 1999; 27 (3) 480-485
    CrossrefPubMedGoogle Scholar
  • 42 Qureshi AI, Palesch YY, Martin R , et al; Antihypertensive Treatment of Acute Cerebral Hemorrhage Study Investigators. Effect of systolic blood pressure reduction on hematoma expansion, perihematomal edema, and 3-month outcome among patients with intracerebral hemorrhage: results from the antihypertensive treatment of acute cerebral hemorrhage study. Arch Neurol 2010; 67 (5) 570-576
    CrossrefPubMedGoogle Scholar
  • 43 Anderson CS, Huang Y, Arima H , et al; INTERACT Investigators. Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke 2010; 41 (2) 307-312
    CrossrefPubMedGoogle Scholar
  • 44 Anderson CS, Heeley E, Huang Y , et al; INTERACT2 Investigators. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 2013; 368 (25) 2355-2365
    CrossrefPubMedGoogle Scholar
  • 45 Qureshi AI, Palesch YY. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II: design, methods, and rationale. Neurocrit Care 2011; 15 (3) 559-576
    CrossrefPubMedGoogle Scholar
  • 46 Qureshi A, Palesch Y ; ATACH II Investigators. Expansion of recruitment time window in Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) II trial. J Vasc Interv Neurol 2012; 5 ( supp ): 6-9
    PubMedGoogle Scholar
  • 47 Tsivgoulis G, Katsanos AH, Butcher KS , et al. Intensive blood pressure reduction in acute intracerebral hemorrhage: a meta-analysis. Neurology 2014; 83 (17) 1523-1529
    CrossrefPubMedGoogle Scholar
  • 48 Gioia LC, Kate M, Dowlatshahi D, Hill MD, Butcher K. Blood pressure management in acute intracerebral hemorrhage: current evidence and ongoing controversies. Curr Opin Crit Care 2015; 21 (2) 99-106
    CrossrefPubMedGoogle Scholar
  • 49 Pan C, Hu Y, Liu N , et al. Aggressive blood pressure lowing therapy in patients with acute intracerebral hemorrhage is safe: a systematic review and meta-analysis. Chin Med J (Engl) 2015; 128 (18) 2524-2529
    CrossrefPubMedGoogle Scholar
  • 50 Hemphill III JC, Greenberg SM, Anderson CS , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46 (7) 2032-2060
    CrossrefPubMedGoogle Scholar
  • 51 Steiner T, Al-Shahi Salman R, Beer R , et al; European Stroke Organisation. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 2014; 9 (7) 840-855
    CrossrefPubMedGoogle Scholar