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Jones, Gary; Hewgley, Hannah; Turner, Stephen; Goyal, Nitin; Pandhi, Abhi

doi: 10.1097/01.ccm.0000528797.61551.29
Research Snapshot Theater: Neuroscience

1Methodist University Hospital, Memphis, TN, 2University of Tennessee, Memphis, TN, 3University of Tennessee Health Sciences Center, Memphis, TN

Learning Objectives: Current intracerebral hemorrhage (ICH) guidelines recommend that rapid lowering of systolic blood pressure (SBP) to < 140 mmHg may be considered in patients presenting with severe hypertension. However, limited data exists regarding the efficacy and safety of this intervention in this population.

Methods: The primary objective of this study was to determine the impact of rapid SBP lowering on the incidence of hematoma expansion in ICH patients presenting with severe hypertension (defined as an SBP > /= 220 mm Hg). Safety analysis included assessing the rate of acute kidney injury (AKI) within 7 days of SBP lowering using the Acute Kidney Injury Network (AKIN) criteria.

Results: A total of 253 ICH patients treated with rapid SBP lowering had at least one follow-up head image available to assess for the primary outcome and were included (SBP > 220 n = 59; SBP 141–219 n = 194). The majority of patients were male (53.0%) and African American (71.1%) with a mean age of 61 years and a history of hypertension prior to admission (82.6%). Time to achieve goal SBP was longer in the severe hypertension group (7.75 vs. 4.5 hours; p < 0.001). Median baseline ICH scores were 1.0 for both groups, with median hematoma volumes also similar (9.2 vs 7.3 ml; p = 0.84). The primary outcome of hematoma expansion was no different between groups (30.5% vs. 31.4%; p = 0.89). However, there was a significant increase in the incidence of AKI in the severe hypertension group (50.8% vs. 29.4%; p = 0.002). Mortality was also similar (20.3% vs 18.6%; p = 0.76), although median duration of hospitalization was significantly longer in those with severe hypertension on admission (8.5 vs 6.0 days; p = 0.049)

Conclusions: Our study observed no difference in the primary efficacy outcome of hematoma expansion in patients presenting with severe hypertension. However, safety analysis revealed significantly higher rates of AKI in the severe hypertension group. Further research is needed to determine the safety of rapid blood pressure control in ICH patients presenting with SBP > 220 mm Hg.

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