Neurocritical Care

, Volume 28, Issue 3, pp 344–352 | Cite as

Impact of Admission Hypertension on Rates of Acute Kidney Injury in Intracerebral Hemorrhage Treated with Intensive Blood Pressure Control

  • Hannah Hewgley
  • Stephen C. Turner
  • Joseph E. Vandigo
  • Jacob Marler
  • Heather Snyder
  • Jason J. Chang
  • G. Morgan JonesEmail author
Original Article



Current guidelines recommend that rapid systolic blood pressure (SBP) lowering to 140 mmHg may be considered in intracerebral hemorrhage (ICH) patients regardless of initial SBP. However, limited safety data exist in patients presenting with varying degrees of severe hypertension. The purpose of this study was to determine whether there was an increased risk of acute kidney injury (AKI) based upon degree of presentation hypertension in ICH patients whose blood pressure was reduced intensively.


This retrospective, cohort study evaluated ICH patients treated with intensive blood pressure control (SBP ≤140 mmHg) who presented with three degrees of presentation hypertension: mild (SBP 141–179 mmHg), moderate (SBP 180–219 mmHg), and severe (SBP ≥ 220 mmHg). Univariate analysis of demographics variables, ICH severity, and factors known to impact AKI was conducted between the three groups. Post hoc testing was used to compare differences between specific groups, with a Bonferroni correction adjusting for multiple comparisons. Additionally, we conducted logistic regression analysis to determine whether baseline SBP group independently predicted AKI.


We included 401 patients (177 with mild, 124 with moderate, and 100 with severe hypertension). There was a significant increase in the prevalence of AKI between groups, with the severe group experiencing the highest rate (p < 0.001). The presence of severe hypertension was also found to independently predict AKI development (odds ratio 2.6; p < 0.001).


Our study observed higher rates of AKI in patients presenting with severe hypertension. Further research is needed to determine the most appropriate strategies for managing blood pressure in ICH patients presenting with higher SBP.


Hypertension Acute kidney injury Intracerebral hemorrhage Blood pressure 


Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

12028_2017_488_MOESM1_ESM.doc (70 kb)
Supplementary material 1 (DOC 69 kb)


  1. 1.
    Sahni R, Weinberger J. Management of intracerebral hemorrhage. Vasc Health Risk Manag. 2007;3:701.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Caceres JA, Goldstein JN. Intracranial hemorrhage. Emerg Med Clin North Am. 2012;30:771–94.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368:2355–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375:1033–43.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Hemphill JC, Greenberg SM, Anderson CS, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke. 2015;46:2032–60.CrossRefPubMedGoogle Scholar
  6. 6.
    Qureshi AI, Palesch YY, Martin R, et al. Systolic blood pressure reduction and risk of acute renal injury in patients with intracerebral hemorrhage. The Am J Med. 2012;125:718-e1–6.CrossRefGoogle Scholar
  7. 7.
    Investigators AToACH. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 2010;38:637–48.CrossRefGoogle Scholar
  8. 8.
    Qureshi AI, Palesch YY, Martin R, et al. 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;67:570–6.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Mohrien KM, Elijovich L, Venable GT, Taylor DR, Jones GM. Intensive blood pressure control during the hyperacute phase of intracerebral hemorrhage in patients at risk for resistant hypertension: a retrospective cohort study. J Crit Care. 2015;30:369–74.CrossRefPubMedGoogle Scholar
  11. 11.
    Erdman MJ, Riha H, Bode L, Chang JJ, Jones GM. Predictors of acute kidney injury in neurocritical care patients receiving continuous hypertonic saline. The Neurohospitalist. 2017;7:9–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Jensen J-US, Hein L, Lundgren B, et al. Kidney failure related to broad-spectrum antibiotics in critically ill patients: secondary end point results from a 1200 patient randomised trial. BMJ Open. 2012;2:e000635.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Gomes DM, Smotherman C, Birch A, et al. Comparison of acute kidney injury during treatment with vancomycin in combination with piperacillin-tazobactam or cefepime. Pharmacother J Human Pharmacol Drug Ther. 2014;34:662–9.CrossRefGoogle Scholar
  14. 14.
    Rossert J. Drug-induced acute interstitial nephritis. Kidney Int. 2001;60:804–17.CrossRefPubMedGoogle Scholar
  15. 15.
    Sedgwick P. Multiple significance tests: the Bonferroni correction. BMJ Br Med J. 2012;344:e509.CrossRefGoogle Scholar
  16. 16.
    Doyle JF, Forni LG. Acute kidney injury: short-term and long-term effects. Crit Care. 2016;20:188.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Snarska K, Kapica-Topczewska K, Bachórzewska-Gajewska H, Małyszko J. Renal function predicts outcomes in patients with ischaemic stroke and haemorrhagic stroke. Kidney Blood Press Res. 2016;41:424–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Strandgaard S, Olesen J, Skinhøj E, Lassen N. Autoregulation of brain circulation in severe arterial hypertension. Br Med J. 1973;1:507–10.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rasool A, Rahman A, Choudhury S, Singh R. Blood pressure in acute intracerebral haemorrhage. J Hum Hypertens. 2004;18:187.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Hannah Hewgley
    • 1
  • Stephen C. Turner
    • 2
  • Joseph E. Vandigo
    • 3
  • Jacob Marler
    • 1
    • 2
  • Heather Snyder
    • 1
    • 2
  • Jason J. Chang
    • 4
  • G. Morgan Jones
    • 1
    • 5
    Email author
  1. 1.Department of PharmacyMethodist University HospitalMemphisUSA
  2. 2.Department of Clinical PharmacyUniversity of Tennessee Health Sciences CenterMemphisUSA
  3. 3.Pharmaceutical Health Services Research DepartmentUniversity of Maryland School of PharmacyBaltimoreUSA
  4. 4.Department of Critical CareMedStar Washington Hospital Medical CenterWashingtonUSA
  5. 5.Department of Clinical Pharmacy, Neurology, and NeurosurgeryUniversity of Tennessee Health Sciences CenterMemphisUSA

Personalised recommendations