title: Is emergent anti-hypertensive treatment beneficial in intracranial hemorrhage?
abstract: A retrospective chart review of adult patients with primary intracranial hemorrhage (ICH) was conducted to determine the effects of emergent anti-hypertensives on mortality. Data included mean arterial pressure (MAP), Glascow Coma Scale score (GCS), ICH size, and anti-hypertensive treatment. Multi-variable logistic regression determined the effect of anti-hypertensives on ICH mortality. Of 66 patients studied, the overall mortality was 30.3%. Mortality was 34.5% for patients initially treated with anti-hypertensives vs. 25.8% for patients not treated. After controlling for age, MAP, GCS, and ICH size, anti-hypertensives given within the first 6 h of presentation were associated with a reduction in mortality with a p value of 0.0375 and an odds ratio of 140 (95% confidence interval [CI] 1.332 to >999). However, this effect may not occur in patients presenting with a systolic blood pressure (SBP)<200 mm Hg. In conclusion, in patients with primary intracranial hemorrhage, there was a significant decrease in mortality associated with emergent anti-hypertensive therapy. A larger prospective study is needed to confirm these findings, define the subgroups that may benefit, and better determine the effect size.
authors.affiliation: Emergency Medicine Residency Program, Resurrection Medical Center, Chicago, Illinois 60631, USA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Burke
authors.forename: Marc
authors.initials: M
authors.lastname: Dorfman
authors.forename: Shu B
authors.initials: SB
authors.lastname: Chan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D015897:Comorbidity; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D007087:Illinois / Q000453:epidemiology; D020300:Intracranial Hemorrhages / Q000188:drug therapy* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents