title: Continuous antihypertensive therapy throughout the initial 24 hours of intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study.
abstract: OBJECTIVE
  A short duration (<24 hours) of antihypertensive therapy (AHT) after acute intracerebral hemorrhage (ICH) may be sufficient because active bleeding generally ceases within several hours. We aimed to determine the association between sequential systolic blood pressure (SBP) levels during AHT and outcomes in ICH patients.
  
  
  METHODS
  In 211 hyperacute ICH patients who underwent AHT based on predefined protocol, the mean of hourly SBP (mSBP) measurements was calculated over 1 to 8 hours (first mSBP), 9 to 16 hours (second mSBP), and 17 to 24 hours (third mSBP) after the initiation of AHT. Outcomes included neurological deterioration (72-hour Glasgow Coma Scale decrease ≥2 or National Instititutes of Health Stroke Scale increase ≥4), hematoma expansion (>33%), and unfavorable outcome (3-month modified Rankin Scale score 4-6).
  
  
  RESULTS
  The median first, second, and third mSBPs were 132, 131, and 137 mm Hg, respectively. A higher first mSBP (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.34-4.69 per 10 mm Hg) or second mSBP (OR, 2.08; 95% CI, 1.20-3.80) was independently associated with neurological deterioration, and a higher second mSBP (OR, 1.40; 95% CI, 1.02-2.00) or third mSBP (OR, 1.45; 95% CI, 1.05-2.05) was associated with unfavorable outcome. None of the mSBPs was associated with hematoma expansion.
  
  
  CONCLUSIONS
  The continuation of AHT throughout the initial 24 hours after ICH may improve outcomes.
authors.affiliation: From the Department of Cerebrovascular Medicine (J.K., E.T., T.O., S.S., K.M., K.T.), Division of Stroke Care Unit (M.K., S.A.), and Department of Neurology (K.N.), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cerebrovascular Medicine, NHO Kyushu Medical Center, Fukuoka, Japan (Y.O.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (K. Kimura); Department of Neurology, Stroke Center, Kobe City Medical Center General Hospital, Kobe, Japan (H.Y.); Department of Neurology, NHO Nagoya Medical Center, Nagoya, Japan (S.O.); Department of Neurology, St Marianna University School of Medicine, Kawasaki, Japan (Y.H.); Department of Neurosurgery and Stroke Center, Kyorin University School of Medicine, Mitaka, Japan (Y.S.); Department of Stroke Neurology, Kohnan Hospital, Sendai, Japan (E.F.); Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan (J.N.); and Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan (K. Kario).
authors.forename: Junpei
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.forename: Eijirou
authors.initials: E
authors.lastname: Tanaka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okuda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shiokawa
authors.forename: Eisuke
authors.initials: E
authors.lastname: Furui
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Takuya
authors.initials: T
authors.lastname: Okata
authors.forename: Shoji
authors.initials: S
authors.lastname: Arihiro
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensives; cerebral hemorrhage; patient outcome assessment; stroke, acute