title: Acute blood pressure reduction in patients with intracerebral hemorrhage does not result in borderzone region hypoperfusion.
abstract: OBJECTIVE
  The Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial (ICH ADAPT) demonstrated blood pressure (BP) reduction does not affect mean perihematoma or hemispheric cerebral blood flow. Nonetheless, portions of the perihematoma and borderzones may reach ischemic thresholds after BP reduction. We tested the hypothesis that BP reduction after intracerebral hemorrhage results in increased critically hypoperfused tissue volumes.
  
  
  METHODS
  Patients with Intracerebral hemorrhage were randomized to a target systolic BP (SBP) of <150 or <180 mm Hg and imaged with computed tomographic perfusion 2 hours later. The volumes of tissue below cerebral blood flow thresholds for ischemia (<18 mL/100 g/min) and infarction (<12 mL/100 g/min) were calculated as a percentage of the total volume within the internal and external borderzones and the perihematoma region.
  
  
  RESULTS
  Seventy-five patients with intracerebral hemorrhage were randomized a median (interquartile range) of 7.8 (13.3) hours from onset. Acute hematoma volume was 17.8 (27.1) mL and mean SBP was 183±22 mm Hg. At the time of computed tomographic perfusion (2.3 [1.0] hours after randomization), SBP was lower in the <150 mm Hg (n=37; 140±18 mm Hg) than in the <180 mm Hg group (n=36; 162±12 mm Hg; P<0.001). BP treatment did not affect the percentage of total borderzone tissue with cerebral blood flow<18 (14.7±13.6 versus 15.6±13.7%; P=0.78) or <12 mL/100 g/min (5.1±5.1 versus 5.8±6.8%; P=0.62). Similar results were found in the perihematoma region. Low SBP load (fraction of time with SBP<150 mmHg) did not predict borderzone tissue volume with cerebral blood flow<18 mL/100 g/min (β=0.023 [-0.073, 0.119]).
  
  
  CONCLUSIONS
  BP reduction does not increase the volume of critically hypoperfused borderzone or perihematoma tissue. These data support the safety of early BP reduction in intracerebral hemorrhage.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00963976.
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Bronwen
authors.initials: B
authors.lastname: Gould
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Rebecca
authors.initials: R
authors.lastname: McCourt
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Laura C
authors.initials: LC
authors.lastname: Gioia
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kate
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Negar
authors.initials: N
authors.lastname: Asdaghi
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Dariush
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Shelagh B
authors.initials: SB
authors.lastname: Coutts
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Derek
authors.initials: D
authors.lastname: Emery
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.).
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.affiliation: From the Division of Neurology (B.G., R.M., L.C.G., M.K., T.J., A.S., K.B.) and Department of Diagnostic Imaging (D.E.), University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada (M.D.H., S.B.C., A.M.D.); Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada (N.A.); and Division of Neurology, University of British Columbia, Ottawa, Ontario, Canada (D.D.). ken.butcher@ualberta.ca.
authors.forename: Ken
authors.initials: K
authors.lastname: Butcher
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D014057:Tomography, X-Ray Computed
keywords: cerebral hemorrhage; hypertension; perfusion imaging