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The impact of hyperacute blood pressure lowering on the early clinical outcome following intracerebral hemorrhage

Itabashi, Ryoa; Toyoda, Kazunoria,b; Yasaka, Masahiroa,b; Kuwashiro, Takahiroa; Nakagaki, Hideakia; Miyashita, Fumioa; Okada, Yasushib; Naritomi, Hiroakia; Minematsu, Kazuoa

doi: 10.1097/HJH.0b013e32830b896d
Original papers: Stroke

Objective Blood pressure lowering in acute intracerebral hemorrhage patients may prevent hematoma growth and neurological deterioration. The optimal goal of hyperacute antihypertensive therapy for intracerebral hemorrhage patients to obtain a favorable early clinical outcome was investigated.

Methods Of 688 consecutive patients who were admitted to our stroke care units within 24 h after intracerebral hemorrhage onset, 244 patients who emergently received intravenous antihypertensive therapy due to admission blood pressure at least 180/105 mmHg were assessed. The average systolic and diastolic blood pressure values 6, 12, and 24 h after admission and the percentage reduction of the blood pressure value with respect to the admission blood pressure value were used for analysis.

Results At 3 weeks, 66 patients (27%) had a completely independent activity level corresponding to a modified Rankin Scale score of 1 or less. After adjustment for baseline characteristics, a favorable functional outcome was more common in patients with the lowest quartile of average systolic blood pressure in the initial 24 h (<138 mmHg, odds ratio 4.36, 95% confidence interval 1.10–17.22), and was similarly common in those with the middle two quartiles (138–148 mmHg, 148–158 mmHg) than in those with the highest quartile of systolic blood pressure (≥158 mmHg). Analyses using patient quartiles on the basis of the average diastolic blood pressure or the reduction of systolic or diastolic blood pressure did not show an association with early outcome.

Conclusion Lowering the systolic blood pressure to less than 138 mmHg during the initial 24 h appears to be predictive of favorable early outcome in intracerebral hemorrhage patients. Randomized controlled trials to answer this question are needed.

aCerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan

bDepartment of Cerebrovascular Disease, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

Received 31 March, 2008

Revised 10 May, 2008

Accepted 04 June, 2008

Correspondence to Kazunori Toyoda, MD, PhD, Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan Tel: +81 6 6833 5012; fax: +81 6 6872 7486; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.