Emergency department control of blood pressure in intracerebral hemorrhage.
BACKGROUND
Early treatment of elevated blood pressure (BP) in patients presenting with spontaneous intracerebral hemorrhage (ICH) may decrease hematoma enlargement and lead to better neurologic outcome.


OBJECTIVE
To determine whether early BP control in patients with spontaneous ICH is both feasible and tolerated when initiated in the Emergency Department (ED).


METHODS
A single-center, prospective observational study in patients with spontaneous ICH was performed to evaluate a protocol to lower, and maintain for 24 h, the mean arterial pressure (MAP) to a range of 100-110 mm Hg within 120 min of arrival to the ED. An additional goal of placing a functional arterial line within 90 min was specified in our protocol. Hematoma volume, neurologic disability, adverse events, and in-hospital mortality were recorded.


RESULTS
A total of 22 patients were enrolled over a 1-year study period. The average time to achieve our target MAP after implementation of our protocol was 123 min (range 19-297 min). The average time to arterial line placement was 84 min (range 36-160 min). Overall, 77% of the patients tolerated the 24-h protocol. The in-hospital mortality rate in this group of patients was 41%.


CONCLUSIONS
Adopting a protocol to reduce and maintain the MAP to a target of 100-110 mm Hg within 120 min of ED arrival was safe and well tolerated in patients presenting with spontaneous ICH. If future trials demonstrate a clinical benefit of early BP control in spontaneous ICH, EDs should implement similar protocols.
Honner
Samantha K
SK
Department of Emergency Medicine, Alameda County Medical Center, Oakland, California 94611, USA.
Singh
Amandeep
A
Cheung
Paul T
PT
Alter
Harrison J
HJ
Dutaret
Claudine G
CG
Patel
Atul K
AK
Acharya
Ananth
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D005240:Feasibility Studies; D005260:Female; D006406:Hematoma / Q000188:drug therapy; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D020299:Intracranial Hemorrhage, Hypertensive / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index
D000959:Antihypertensive Agents