title: Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement.
abstract: OBJECTIVE
  The association between elevated blood pressure (BP) and hematoma enlargement in acute intracerebral hemorrhage (ICH) has not been clarified. We investigated the association between maximum systolic BP (SBP) and hematoma enlargement, measuring SBP between a baseline and a second CT scan in patients with hypertensive ICH.
  
  
  METHODS
  We assessed 76 consecutive patients with hypertensive ICH retrospectively. We usually attempted to lower SBP below targets of 140, 150, or 160 mm Hg. Recordings of serial BP from admission until the second CT scan were assessed. A neuroradiologist, who was not informed of the aim of this study, reviewed CT films. Hematoma enlargement was defined as an increase in volume of > or =140% or 12.5 cm3.
  
  
  RESULTS
  Hematoma enlargement occurred in 16 patients. Maximum SBP was significantly associated with hematoma enlargement (P=0.0074). A logistic regression model for predicting hematoma enlargement was constructed with the use of maximum SBP, hematoma volume, and Glasgow Coma Scale score at admission. After adjustment for these factors, maximum SBP was independently associated with hematoma enlargement (odds ratio per mm Hg, 1.04; 95% CI, 1.01 to 1.07). Target SBPs of > or =160 mm Hg were significantly associated with hematoma enlargement compared with those of < or =150 mm Hg (P=0.025).
  
  
  CONCLUSIONS
  Our findings suggest that elevated BP increases the risk of hematoma enlargement. Efforts to lower SBP below 150 mm Hg may prevent this risk.
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo 173-8605, Japan. ns-waki@med.teikyo-u.ac.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohwaki
authors.forename: Eiji
authors.initials: E
authors.lastname: Yano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagashima
authors.forename: Masafumi
authors.initials: M
authors.lastname: Hirata
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Nakagomi
authors.forename: Akira
authors.initials: A
authors.lastname: Tamura
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents