title: Blood pressure reduction does not reduce perihematoma oxygenation: a CT perfusion study.
abstract: Blood pressure (BP) reduction after intracerebral hemorrhage (ICH) is controversial, because of concerns that this may cause critical reductions in perihematoma perfusion and thereby precipitate tissue damage. We tested the hypothesis that BP reduction reduces perihematoma tissue oxygenation.Acute ICH patients were randomized to a systolic BP target of <150 or <180 mm Hg. Patients underwent CT perfusion (CTP) imaging 2 hours after randomization. Maps of cerebral blood flow (CBF), maximum oxygen extraction fraction (OEF(max)), and the resulting maximum cerebral metabolic rate of oxygen (CMRO2(max)) permitted by local hemodynamics, were calculated from raw CTP data.Sixty-five patients (median (interquartile range) age 70 (20)) were imaged at a median (interquartile range) time from onset to CTP of 9.8 (13.6) hours. Mean OEF(max) was elevated in the perihematoma region (0.44±0.12) relative to contralateral tissue (0.36±0.11; P<0.001). Perihematoma CMRO2(max) (3.40±1.67 mL/100 g per minute) was slightly lower relative to contralateral tissue (3.63±1.66 mL/100 g per minute; P=0.025). Despite a significant difference in systolic BP between the aggressive (140.5±18.7 mm Hg) and conservative (163.0±10.6 mm Hg; P<0.001) treatment groups, perihematoma CBF was unaffected (37.2±11.9 versus 35.8±9.6 mL/100 g per minute; P=0.307). Similarly, aggressive BP treatment did not affect perihematoma OEF(max) (0.43±0.12 versus 0.45±0.11; P=0.232) or CMRO2(max) (3.16±1.66 versus 3.68±1.85 mL/100 g per minute; P=0.857). Blood pressure reduction does not affect perihematoma oxygen delivery. These data support the safety of early aggressive BP treatment in ICH.
authors.affiliation: Division of Neurology, Department of Medicine, WMC Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: Mahesh P
authors.initials: MP
authors.lastname: Kate
authors.affiliation: Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark.
authors.forename: Mikkel B
authors.initials: MB
authors.lastname: Hansen
authors.affiliation: Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Mouridsen
authors.affiliation: Center of Functionally Integrative Neuroscience and MINDLab, Aarhus University, Aarhus, Denmark.
authors.forename: Leif
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: Division of Neurology, Department of Medicine, WMC Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Choi
authors.affiliation: Division of Neurology, Department of Medicine, WMC Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: Bronwen E
authors.initials: BE
authors.lastname: Gould
authors.affiliation: Division of Neurology, Department of Medicine, WMC Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: McCourt
authors.affiliation: Department of Clinical Neurosciences University of Calgary, Calgary, Alberta, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: Department of Clinical Neurosciences University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: Department of Clinical Neurosciences University of Calgary, Calgary, Alberta, Canada.
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.affiliation: Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Dariush
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Emery
authors.affiliation: Division of Neurology, Department of Medicine, WMC Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Buck
authors.affiliation: Division of Neurology, Department of Medicine, WMC Health Sciences Centre, Edmonton, Alberta, Canada.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Butcher
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D006801:Humans; D006830:Hydralazine / Q000008:administration & dosage / Q000627:therapeutic use; D007741:Labetalol / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D010101:Oxygen Consumption / Q000187:drug effects*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D006830:Hydralazine; D007741:Labetalol
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