title: Blood pressure management in acute intracerebral haemorrhage guidelines are poorly implemented in clinical practice.
abstract: BACKGROUND
  Optimal management of blood pressure (BP) in spontaneous intracerebral haemorrhage (ICH) is controversial. We assessed adherence to BP guidelines and its management in ICH in a tertiary Canadian Stroke Centre.
  
  
  METHODS
  We conducted a retrospective analysis of 142 CT confirmed primary ICH patients admitted within 24h of symptoms between 2005 and 2006. Initial practice with respect to BP control was reviewed and compared with current guidelines. This retrospective sample was compared with a prospective cohort participating in a BP lowering trial for the attainment of pre-defined BP targets. We also assessed the effect of BP treatment on hematoma expansion and mortality.
  
  
  RESULTS
  Blood pressure treatment orders were established in 73% of the 142 patients (median age 71 years, 61% male). Only 26% of patients had target orders as advised in the current AHA guidelines. Only 54% achieved BP targets as compared with 83% of the prospective cohort within 1h. Patients with established BP orders were more likely to have repeat brain imaging (70.2%) than those without (39.5%; p=0.001 Mortality rates were 29.8% and 47.4% in those with and without BP targets respectively (p=0.051).
  
  
  CONCLUSIONS
  Management of BP varies considerably and there appears to be little adherence to recommended guidelines. Targets are achieved more rapidly if a BP treatment protocol is utilized.
authors.affiliation: Department of Stroke Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Dulka
authors.initials: D
authors.lastname: Manawadu
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.forename: Amrita
authors.initials: A
authors.lastname: Roy
authors.forename: Kim
authors.initials: K
authors.lastname: Orwaard-Wong
authors.forename: Ken
authors.initials: K
authors.lastname: Butcher
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome