The intracerebral hemorrhage acutely decreasing arterial pressure trial

Kenneth S. Butcher, Thomas Jeerakathil, Michael Hill, Andrew M. Demchuk, Dariush Dowlatshahi, Shelagh B. Coutts, Bronwen Gould, Rebecca McCourt, Negar Asdaghi, J. Max Findlay, Derek Emery, Ashfaq Shuaib

Research output: Contribution to journalArticle

127 Citations (Scopus)

Abstract

Background and Purpose-Acute blood pressure (BP) reduction aimed at attenuation of intracerebral hemorrhage (ICH) expansion might also compromise cerebral blood flow (CBF). We tested the hypothesis that CBF in acute ICH patients is unaffected by BP reduction. Methods-Patients with spontaneous ICH <24 hours after onset and systolic BP > 150 mm Hg were randomly assigned to an intravenous antihypertensive treatment protocol targeting a systolic BP of <150 mm Hg (n=39) or <180 mm Hg (n=36). Patients underwent computed tomography perfusion imaging 2 hours postrandomization. The primary end point was perihematoma relative (relative CBF). Results-Treatment groups were balanced with respect to baseline systolic BP: 182±20 mm Hg (<150 mm Hg target group) versus 184±25 mm Hg (<180 mm Hg target group; P=0.60), and for hematoma volume: 25.6±30.8 versus 26.9±25.2 mL (P=0.66). Mean systolic BP 2 hours after randomization was significantly lower in the <150 mm Hg target group (140±19 vs 162±12 mm Hg; P<0.001). Perihematoma CBF (38.7±11.9 mL/100 g per minute) was lower than in contralateral homologous regions (44.1±11.1 mL/100 g per minute; P<0.001) in all patients. The primary end point of perihematoma relative CBF in the <150 mm Hg target group (0.86±0.12) was not significantly lower than that in the <180 mm Hg group (0.89±0.09; P=0.19; absolute difference, 0.03; 95% confidence interval -0.018 to 0.078). There was no relationship between the magnitude of BP change and perihematoma relative CBF in the <150 mm Hg (R=0.00005; 95% confidence interval, -0.001 to 0.001) or <180 mm Hg target groups (R=0.000; 95% confidence interval, -0.001 to 0.001). Conclusions-Rapid BP lowering after a moderate volume of ICH does not reduce perihematoma CBF. These physiological data indicate that acute BP reduction does not precipitate cerebral ischemia in ICH patients.

Original languageEnglish (US)
Pages (from-to)620-626
Number of pages7
JournalStroke
Volume44
Issue number3
DOIs
StatePublished - Mar 2013
Externally publishedYes

Fingerprint

Cerebral Hemorrhage
Cerebrovascular Circulation
Arterial Pressure
Blood Pressure
Confidence Intervals
Perfusion Imaging
Clinical Protocols
Random Allocation
Brain Ischemia
Hematoma
Antihypertensive Agents
Tomography

Keywords

  • Cerebral blood flow
  • Computed tomography perfusion
  • Hypertension

ASJC Scopus subject areas

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

Cite this

Butcher, K. S., Jeerakathil, T., Hill, M., Demchuk, A. M., Dowlatshahi, D., Coutts, S. B., ... Shuaib, A. (2013). The intracerebral hemorrhage acutely decreasing arterial pressure trial. Stroke, 44(3), 620-626. https://doi.org/10.1161/STROKEAHA.111.000188

The intracerebral hemorrhage acutely decreasing arterial pressure trial. / Butcher, Kenneth S.; Jeerakathil, Thomas; Hill, Michael; Demchuk, Andrew M.; Dowlatshahi, Dariush; Coutts, Shelagh B.; Gould, Bronwen; McCourt, Rebecca; Asdaghi, Negar; Findlay, J. Max; Emery, Derek; Shuaib, Ashfaq.

In: Stroke, Vol. 44, No. 3, 03.2013, p. 620-626.

Research output: Contribution to journalArticle

Butcher, KS, Jeerakathil, T, Hill, M, Demchuk, AM, Dowlatshahi, D, Coutts, SB, Gould, B, McCourt, R, Asdaghi, N, Findlay, JM, Emery, D & Shuaib, A 2013, 'The intracerebral hemorrhage acutely decreasing arterial pressure trial', Stroke, vol. 44, no. 3, pp. 620-626. https://doi.org/10.1161/STROKEAHA.111.000188
Butcher KS, Jeerakathil T, Hill M, Demchuk AM, Dowlatshahi D, Coutts SB et al. The intracerebral hemorrhage acutely decreasing arterial pressure trial. Stroke. 2013 Mar;44(3):620-626. https://doi.org/10.1161/STROKEAHA.111.000188
Butcher, Kenneth S. ; Jeerakathil, Thomas ; Hill, Michael ; Demchuk, Andrew M. ; Dowlatshahi, Dariush ; Coutts, Shelagh B. ; Gould, Bronwen ; McCourt, Rebecca ; Asdaghi, Negar ; Findlay, J. Max ; Emery, Derek ; Shuaib, Ashfaq. / The intracerebral hemorrhage acutely decreasing arterial pressure trial. In: Stroke. 2013 ; Vol. 44, No. 3. pp. 620-626.
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abstract = "Background and Purpose-Acute blood pressure (BP) reduction aimed at attenuation of intracerebral hemorrhage (ICH) expansion might also compromise cerebral blood flow (CBF). We tested the hypothesis that CBF in acute ICH patients is unaffected by BP reduction. Methods-Patients with spontaneous ICH <24 hours after onset and systolic BP > 150 mm Hg were randomly assigned to an intravenous antihypertensive treatment protocol targeting a systolic BP of <150 mm Hg (n=39) or <180 mm Hg (n=36). Patients underwent computed tomography perfusion imaging 2 hours postrandomization. The primary end point was perihematoma relative (relative CBF). Results-Treatment groups were balanced with respect to baseline systolic BP: 182±20 mm Hg (<150 mm Hg target group) versus 184±25 mm Hg (<180 mm Hg target group; P=0.60), and for hematoma volume: 25.6±30.8 versus 26.9±25.2 mL (P=0.66). Mean systolic BP 2 hours after randomization was significantly lower in the <150 mm Hg target group (140±19 vs 162±12 mm Hg; P<0.001). Perihematoma CBF (38.7±11.9 mL/100 g per minute) was lower than in contralateral homologous regions (44.1±11.1 mL/100 g per minute; P<0.001) in all patients. The primary end point of perihematoma relative CBF in the <150 mm Hg target group (0.86±0.12) was not significantly lower than that in the <180 mm Hg group (0.89±0.09; P=0.19; absolute difference, 0.03; 95{\%} confidence interval -0.018 to 0.078). There was no relationship between the magnitude of BP change and perihematoma relative CBF in the <150 mm Hg (R=0.00005; 95{\%} confidence interval, -0.001 to 0.001) or <180 mm Hg target groups (R=0.000; 95{\%} confidence interval, -0.001 to 0.001). Conclusions-Rapid BP lowering after a moderate volume of ICH does not reduce perihematoma CBF. These physiological data indicate that acute BP reduction does not precipitate cerebral ischemia in ICH patients.",
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AU - Coutts, Shelagh B.

AU - Gould, Bronwen

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AU - Asdaghi, Negar

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N2 - Background and Purpose-Acute blood pressure (BP) reduction aimed at attenuation of intracerebral hemorrhage (ICH) expansion might also compromise cerebral blood flow (CBF). We tested the hypothesis that CBF in acute ICH patients is unaffected by BP reduction. Methods-Patients with spontaneous ICH <24 hours after onset and systolic BP > 150 mm Hg were randomly assigned to an intravenous antihypertensive treatment protocol targeting a systolic BP of <150 mm Hg (n=39) or <180 mm Hg (n=36). Patients underwent computed tomography perfusion imaging 2 hours postrandomization. The primary end point was perihematoma relative (relative CBF). Results-Treatment groups were balanced with respect to baseline systolic BP: 182±20 mm Hg (<150 mm Hg target group) versus 184±25 mm Hg (<180 mm Hg target group; P=0.60), and for hematoma volume: 25.6±30.8 versus 26.9±25.2 mL (P=0.66). Mean systolic BP 2 hours after randomization was significantly lower in the <150 mm Hg target group (140±19 vs 162±12 mm Hg; P<0.001). Perihematoma CBF (38.7±11.9 mL/100 g per minute) was lower than in contralateral homologous regions (44.1±11.1 mL/100 g per minute; P<0.001) in all patients. The primary end point of perihematoma relative CBF in the <150 mm Hg target group (0.86±0.12) was not significantly lower than that in the <180 mm Hg group (0.89±0.09; P=0.19; absolute difference, 0.03; 95% confidence interval -0.018 to 0.078). There was no relationship between the magnitude of BP change and perihematoma relative CBF in the <150 mm Hg (R=0.00005; 95% confidence interval, -0.001 to 0.001) or <180 mm Hg target groups (R=0.000; 95% confidence interval, -0.001 to 0.001). Conclusions-Rapid BP lowering after a moderate volume of ICH does not reduce perihematoma CBF. These physiological data indicate that acute BP reduction does not precipitate cerebral ischemia in ICH patients.

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