Advertisement

Blood Pressure Management in ICH

  • Shahram Majidi
  • Adnan I. Qureshi
Chapter

Abstract

Elevated systolic blood pressure is very common in patients with acute intracerebral hemorrhage, and it is a well-recognized risk factor for hematoma expansion, neurological deterioration, and poor clinical outcome in these patients. Multiple clinical trials have indicated the safety of acute blood pressure lowering in patients with ICH. However, ATACH II and INTERACT II clinical trials both failed to demonstrate significant improvement in clinical outcome in patients with acute hypertensive intracerebral hemorrhage following intensive blood pressure reduction defined as systolic blood pressure less than 140 mmHg in comparison to standard systolic blood pressure reduction to less than 180 mmHg. It is important to emphasize that the safety and efficacy of intensive blood pressure lowering in patients with unfavorable characteristics such as hematoma volume greater than 30 ml, midline shift, and increased intracranial pressure and patients with lower GCS score remain unclear as overwhelming majority of patients in ATACH II and INTERACT II trials had favorable baseline clinical characteristics. In summary, based on current data and until future trials provide further evidence on safety and efficacy of intensive blood pressure reduction in more specific and individualized subgroups of patients, systolic blood pressure lowering to 140–160 mmHg seems a reasonable blood pressure goal for patients with acute intracerebral hemorrhage.

Keywords

Intracerebral hemorrhage Systolic blood pressure Acute hypertensive response Antihypertensive therapy Intensive blood pressure reduction Hematoma expansion Safety Neurological deterioration Clinical outcome 

References

  1. 1.
    Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke. 2003;34(8):2060–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Britton M, Carlsson A, de Faire U. Blood pressure course in patients with acute stroke and matched controls. Stroke. Sep-Oct 1986;17(5):861–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Morfis L, Schwartz RS, Poulos R, Howes LG. Blood pressure changes in acute cerebral infarction and hemorrhage. Stroke. 1997;28(7):1401–5.CrossRefPubMedGoogle Scholar
  4. 4.
    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):32–8.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ahmed N, Nasman P, Wahlgren NG. Effect of intravenous nimodipine on blood pressure and outcome after acute stroke. Stroke. Jun 2000;31(6):1250–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Lacy CR, Suh DC, Bueno M, Kostis JB. Delay in presentation and evaluation for acute stroke: stroke time registry for outcomes knowledge and epidemiology (S.T.R.O.K.E.). Stroke. 2001;32(1):63–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Qureshi AI, Geocadin RG, Suarez JI, Ulatowski JA. Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions. Crit Care Med. 2000;28(5):1556–64.CrossRefPubMedGoogle Scholar
  8. 8.
    Hilz MJ, Devinsky O, Szczepanska H, Borod JC, Marthol H, Tutaj M. Right ventromedial prefrontal lesions result in paradoxical cardiovascular activation with emotional stimuli. Brain. 2006;129(Pt 12):3343–55.CrossRefPubMedGoogle Scholar
  9. 9.
    Nason MW Jr, Mason P. Modulation of sympathetic and somatomotor function by the ventromedial medulla. J Neurophysiol. 2004;92(1):510–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Kazui S, Minematsu K, Yamamoto H, Sawada T, Yamaguchi T. Predisposing factors to enlargement of spontaneous intracerebral hematoma. Stroke. 1997;28(12):2370–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Broderick JP, Brott TG, Tomsick T, Barsan W, Spilker J. Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg. 1990;72(2):195–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Dandapani BK, Suzuki S, Kelley RE, Reyes-Iglesias Y, Duncan RC. Relation between blood pressure and outcome in intracerebral hemorrhage. Stroke. 1995;26(1):21–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Sakamoto Y, Koga M, Yamagami H, et al. Systolic blood pressure after intravenous antihypertensive treatment and clinical outcomes in hyperacute intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. Stroke. 2013;44(7):1846–51.CrossRefPubMedGoogle Scholar
  14. 14.
    Sakamoto Y, Koga M, Todo K, et al. Relative systolic blood pressure reduction and clinical outcomes in hyperacute intracerebral hemorrhage: the SAMURAI-ICH observational study. J Hypertens. 2015;33(5):1069–73.CrossRefPubMedGoogle Scholar
  15. 15.
    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):1364–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Steiner T, Diringer MN, Schneider D, et al. Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII. Neurosurgery. 2006;59(4):767–73. discussion 773–764CrossRefPubMedGoogle Scholar
  17. 17.
    Mayer SA, Brun NC, Begtrup K, et al. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2005;352(8):777–85.CrossRefPubMedGoogle Scholar
  18. 18.
    Mayer SA, Brun NC, Broderick J, et al. Safety and feasibility of recombinant factor VIIa for acute intracerebral hemorrhage. Stroke. 2005;36(1):74–9.CrossRefGoogle Scholar
  19. 19.
    Mayer SA, Brun NC, Broderick J, et al. Recombinant activated factor VII for acute intracerebral hemorrhage: US phase IIA trial. Neurocrit Care. 2006;4(3):206–14.CrossRefPubMedGoogle Scholar
  20. 20.
    Brott T, Broderick J, Kothari R, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28(1):1–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Davis SM, Broderick J, Hennerici M, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66(8):1175–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Kazui S, Naritomi H, Yamamoto H, Sawada T, Yamaguchi T. Enlargement of spontaneous intracerebral hemorrhage. Incidence and time course. Stroke. 1996;27(10):1783–7.CrossRefPubMedGoogle Scholar
  23. 23.
    Mayer SA, Brun NC, Begtrup K, et al. Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med. 2008;358(20):2127–37.CrossRefPubMedGoogle Scholar
  24. 24.
    Mayer SA, Davis SM, Skolnick BE, et al. Can a subset of intracerebral hemorrhage patients benefit from hemostatic therapy with recombinant activated factor VII? Stroke. 2009;40(3):833–40.CrossRefPubMedGoogle Scholar
  25. 25.
    Qureshi AI, Palesch YY. Antihypertensive treatment of acute cerebral hemorrhage (ATACH) II: design, methods, and rationale. Neurocrit Care. 2011;15(3):559–76.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mayer SA, Sacco RL, Shi T, Mohr JP. Neurologic deterioration in noncomatose patients with supratentorial intracerebral hemorrhage. Neurology. 1994;44(8):1379–84.CrossRefPubMedGoogle Scholar
  27. 27.
    Zazulia AR, Diringer MN, Videen TO, et al. Hypoperfusion without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab. 2001;21(7):804–10.CrossRefPubMedGoogle Scholar
  28. 28.
    Butcher KS, Baird T, MacGregor L, Desmond P, Tress B, Davis S. Perihematomal edema in primary intracerebral hemorrhage is plasma derived. Stroke. 2004;35(8):1879–85.CrossRefPubMedGoogle Scholar
  29. 29.
    Butcher KS, Jeerakathil T, Hill M, et al. The Intracerebral hemorrhage acutely decreasing arterial pressure trial. Stroke. 2013;44(3):620–6.CrossRefPubMedGoogle Scholar
  30. 30.
    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
  31. 31.
    Antihypertensive Treatment of Acute Cerebral Hemorrhage i. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 2010;38(2):637–48.CrossRefGoogle Scholar
  32. 32.
    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. May 2010;67(5):570–6.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Anderson CS, Huang Y, Wang JG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008;7(5):391–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368(25):2355–65.CrossRefPubMedGoogle Scholar
  35. 35.
    Wang X, Arima H, Heeley E, et al. Magnitude of blood pressure reduction and clinical outcomes in acute intracerebral hemorrhage: intensive blood pressure reduction in acute cerebral hemorrhage trial study. Hypertension. 2015;65(5):1026–32.CrossRefPubMedGoogle Scholar
  36. 36.
    Sato S, Carcel C, Anderson CS. Blood pressure management after Intracerebral hemorrhage. Curr Treat Options Neurol. 2015;17(12):49.CrossRefPubMedGoogle Scholar
  37. 37.
    Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. 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):2032–60.CrossRefPubMedGoogle Scholar
  38. 38.
    Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375(11):1033–43.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Prabhakaran S, Naidech AM. Ischemic brain injury after intracerebral hemorrhage: a critical review. Stroke. Aug 2012;43(8):2258–63.CrossRefPubMedGoogle Scholar
  40. 40.
    Garg RK, Liebling SM, Maas MB, Nemeth AJ, Russell EJ, Naidech AM. Blood pressure reduction, decreased diffusion on MRI, and outcomes after intracerebral hemorrhage. Stroke. 2012;43(1):67–71.CrossRefPubMedGoogle Scholar
  41. 41.
    Majidi S, Suarez JI, Qureshi AI. Management of acute hypertensive response in intracerebral hemorrhage patients after ATACH-2 trial. Neurocrit Care. 2016;  https://doi.org/10.1007/s12028-016-0341-z. PMID: 28004328.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Shahram Majidi
    • 1
  • Adnan I. Qureshi
    • 2
  1. 1.Department of NeurosurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.University of MinnesotaMinneapolisUSA

Personalised recommendations