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Therapeutic Variation in Lowering Blood Pressure: Effects on Intracranial Pressure in Acute Intracerebral Haemorrhage

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Abstract

Introduction

Intracerebral haemorrhage (ICH) is associated with high morbidity and mortality. Blood pressure (BP) control is one of the main management strategies in acute ICH. Limited data currently exist regarding intracranial pressure (ICP) in acute ICH. The relationship between BP lowering and ICP is yet to be fully elucidated.

Methods

We conducted a systematic review to investigate the effects of BP lowering on ICP in acute ICH. The study protocol was registered on PROSPERO (CRD42019134470).

Results

Following PRISMA guidelines, MEDLINE, EMBASE and CENTRAL were searched for studies on ICH with BP and ICP or surrogate measures. 1096 articles were identified after duplicates were removed; 18 studies meeting the inclusion criteria. Dihydropyridine calcium channel blockers (CCBs) were the most common agent used to lower BP, but had a varying effect on ICP. Other BP-lowering agents used also had a varying effect on ICP.

Discussion and Conclusion

Further work, including large observational or randomized interventional studies, is needed to develop a better understanding of the effect of BP lowering on ICP in acute ICH, which will assist the development of more effective management strategies.

Trial Registration

The study protocol was registered on PROSPERO (CRD42019134470) on 29/05/2019.

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Authors and Affiliations

  1. Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Cardiovascular Sciences Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

    Meeriam Kadicheeni, Thompson G. Robinson & Jatinder S. Minhas

  2. National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK

    Thompson G. Robinson & Jatinder S. Minhas

  3. University Hospitals of Leicester NHS Trust, Leicester, UK

    Pip Divall

  4. Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK

    Adrian R. Parry-Jones

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  1. Meeriam Kadicheeni
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  2. Thompson G. Robinson
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  3. Pip Divall
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  4. Adrian R. Parry-Jones
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  5. Jatinder S. Minhas
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Corresponding author

Correspondence to Meeriam Kadicheeni.

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Funding

MK is an NIHR Academic Clinical Fellow. JSM is an NIHR Clinical Lecturer in Older People and Complex Health Needs. APJ is an NIHR Clinician Scientist. TGR is an NIHR Senior Investigator. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health, or the authors’ respective institutions.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Author contributions

MK, TGR, APJ and JSM conceived and designed the review. MK, PD and JSM searched and selected the studies. MK and JSM prepared the figures. All authors read and approved the final manuscript.

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Kadicheeni, M., Robinson, T.G., Divall, P. et al. Therapeutic Variation in Lowering Blood Pressure: Effects on Intracranial Pressure in Acute Intracerebral Haemorrhage. High Blood Press Cardiovasc Prev 28, 115–128 (2021). https://doi.org/10.1007/s40292-021-00435-z

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