Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion

Bronwen Gould, Rebecca McCourt, Laura C. Gioia, Mahesh Kate, Michael D. Hill, Negar Asdaghi, Dariush Dowlatshahi, Thomas Jeerakathil, Shelagh B. Coutts, Andrew M. Demchuk, Derek Emery, Ashfaq Shuaib, Ken Butcher

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

BACKGROUND AND PURPOSE -: The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT) demonstrated blood pressure (BP) reduction does not affect mean perihematoma or hemispheric cerebral blood flow. Nonetheless, portions of the perihematoma and borderzones may reach ischemic thresholds after BP reduction. We tested the hypothesis that BP reduction after intracerebral hemorrhage results in increased critically hypoperfused tissue volumes. METHODS -: Patients with Intracerebral hemorrhage were randomized to a target systolic BP (SBP) of <150 or <180 mm Hg and imaged with computed tomographic perfusion 2 hours later. The volumes of tissue below cerebral blood flow thresholds for ischemia (<18 mL/100 g/min) and infarction (<12 mL/100 g/min) were calculated as a percentage of the total volume within the internal and external borderzones and the perihematoma region. RESULTS -: Seventy-five patients with intracerebral hemorrhage were randomized a median (interquartile range) of 7.8 (13.3) hours from onset. Acute hematoma volume was 17.8 (27.1) mL and mean SBP was 183±22 mm Hg. At the time of computed tomographic perfusion (2.3 [1.0] hours after randomization), SBP was lower in the <150 mm Hg (n=37; 140±18 mm Hg) than in the <180 mm Hg group (n=36; 162±12 mm Hg; P<0.001). BP treatment did not affect the percentage of total borderzone tissue with cerebral blood flow <18 (14.7±13.6 versus 15.6±13.7%; P=0.78) or <12 mL/100 g/min (5.1±5.1 versus 5.8±6.8%; P=0.62). Similar results were found in the perihematoma region. Low SBP load (fraction of time with SBP<150 mmHg) did not predict borderzone tissue volume with cerebral blood flow <18 mL/100 g/min (β=0.023 [-0.073, 0.119]). CONCLUSIONS -: BP reduction does not increase the volume of critically hypoperfused borderzone or perihematoma tissue. These data support the safety of early BP reduction in intracerebral hemorrhage. CLINICAL TRIAL REGISTRATION -: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00963976.

Original languageEnglish (US)
Pages (from-to)2894-2899
Number of pages6
JournalStroke
Volume45
Issue number10
DOIs
StatePublished - Oct 12 2014

Keywords

  • cerebral hemorrhage
  • hypertension
  • perfusion imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Gould, B., McCourt, R., Gioia, L. C., Kate, M., Hill, M. D., Asdaghi, N., Dowlatshahi, D., Jeerakathil, T., Coutts, S. B., Demchuk, A. M., Emery, D., Shuaib, A., & Butcher, K. (2014). Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion. Stroke, 45(10), 2894-2899. https://doi.org/10.1161/STROKEAHA.114.005614