Does early intensive lowering of blood pressure reduce hematoma volume and improve clinical outcome after acute cerebral hemorrhage?
BACKGROUND
Intracerebral hemorrhage (ICH) is a poorly understood condition with devastating results. Despite the personal and social impact of ICH, modern medicine can offer little hope. Surgery is the longest-standing therapy, but with no demonstrated evidence of positive effect. Reduction of the early hypertension seen with ICH is believed to limit hematoma growth and improve clinical outcome. The effectiveness and safety of an early, aggressive blood-pressure-lowering strategy for ICH patients has only recently been examined in randomized controlled trials.


OBJECTIVE
Does early, intensive lowering of blood pressure reduce hematoma volume and improve clinical outcome after acute cerebral hemorrhage?


METHODS
Two trials assessing the clinical impact of blood pressure lowering in intracerebral hemorrhage were acquired and appraised.


RESULTS
The two randomized trials incorporated similar parallel designs and both trials measured clinical outcomes and short-term change in hematoma size. The smaller trial was only partially blinded and showed no difference in any of the outcomes; the large trial demonstrated marginal reduction in proportional hematoma growth, but no significant difference in clinical outcome.


CONCLUSIONS
There is currently insufficient evidence to support the routine practice of lowering blood pressure of patients suffering an acute intracerebral hemorrhage.
Worster
Andrew
A
Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada.
Keim
Samuel M
SM
Carpenter
Christopher R
CR
Adeoye
Opeolu
O
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006406:Hematoma / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged
D000959:Antihypertensive Agents