Blood pressure management in acute intracerebral haemorrhage: low blood pressure and early neurological deterioration.
OBJECTIVE
Lowering the blood pressure (BP) of patients with intracerebral haemorrhage (ICH) can prevent haematoma enlargement but may also promote secondary infarction in areas adjacent to the haematoma, which can lead to neurological deterioration. Little is known about the effects of low BP on early neurological deterioration (END). We conducted a retrospective study to determine whether low BP after admission was associated with END in patients with acute ICH.


METHODS
We investigated 100 consecutive patients diagnosed with spontaneous ICH. We obtained data on minimum systolic blood pressure (SBP) in the 24 h after admission and related factors and assessed END in this time window.


RESULTS
END occurred in 38 patients. The frequencies of END by minimum SBP quartile were 52% ( <or= 100 mmHg), 29% (100-120 mmHg), 14% (120-130 mmHg), and 48% ( > 130 mmHg). A logistic regression model for predicting END was developed using SBP at admission, Glasgow Coma Scale at admission, haematoma volume, minimum SBP, and squared minimum SBP. A U-shaped relationship between minimum SBP and END (p = 0.02) was observed, with the lowest risk for END at a minimum SBP of 123 mmHg. The curve was nearly flat for a minimum SBP of 115-130 mmHg, indicating that the risk of END is relatively low across this range of minimum SBPs.


CONCLUSIONS
Our findings suggest that a minimum SBP of approximately 120-125 mmHg after admission is associated with a beneficial impact on a reduced risk of END.
Ohwaki
Kazuhiro
K
Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. ns-waki@med.teikyo-u.ac.jp
Yano
Eiji
E
Nagashima
Hiroshi
H
Hirata
Masafumi
M
Nakagomi
Tadayoshi
T
Tamura
Akira
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006406:Hematoma / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000959:Antihypertensive Agents