Cerebral ischemia and deterioration with lower blood pressure target in intracerebral hemorrhage

Andrew B. Buletko, Tapan Thacker, Sung Min Cho, Jason Mathew, Nicolas R. Thompson, Natalie Organek, Jennifer A. Frontera, Ken Uchino

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Abstract

OBJECTIVE: To determine the incidence and predictors of acute cerebral ischemia and neurologic deterioration in intracerebral hemorrhage (ICH) patients after an institutional protocol change in systolic blood pressure (SBP) target from <160 to <140 mm Hg. METHODS: We retrospectively compared persons admitted with primary ICH before and after a protocol change in SBP target from <160 to <140 mm Hg. The primary outcomes were presence of acute cerebral ischemia on MRI completed within 2 weeks of ICH and acute neurologic deterioration. RESULTS: Of 286 persons with primary ICH, 119 underwent MRI and met inclusion criteria. Sixty-two had a target SBP <160 mm Hg (group 1) and 57 had a target SBP <140 mm Hg (group 2). There were no differences between the 2 groups in baseline clinical and radiographic characteristics, but over the first 24 hours of hospitalization, group 2 had lower mean SBP (134 vs 143 mm Hg, p < 0.001) and lower minimum SBP over 72 hours (106 vs 112 mm Hg, p = 0.02). Acute cerebral ischemia was more frequent in group 2 than in group 1 (32% vs 16%; p = 0.047) as was acute neurologic deterioration (19% vs 5%; p = 0.022). A minimum SBP ≤120 mm Hg over 72 hours was associated with cerebral ischemia, while no patient with a minimum SBP ≥130 mm Hg had cerebral ischemia. Acute cerebral ischemia was significantly associated with worse discharge NIH Stroke Scale score, while SBP target was not. CONCLUSIONS: Intensive lowering of SBP <140 mm Hg in acute ICH, particularly allowing SBP <120 mm Hg, is associated with increased remote cerebral ischemic lesions and acute neurologic deterioration.

Original languageEnglish (US)
Pages (from-to)e1058-e1066
JournalNeurology
Volume91
Issue number11
DOIs
StatePublished - Sep 11 2018
Externally publishedYes

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ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Buletko, A. B., Thacker, T., Cho, S. M., Mathew, J., Thompson, N. R., Organek, N., Frontera, J. A., & Uchino, K. (2018). Cerebral ischemia and deterioration with lower blood pressure target in intracerebral hemorrhage. Neurology, 91(11), e1058-e1066. https://doi.org/10.1212/WNL.0000000000006156