title: Cerebral Perfusion Pressure is Maintained in Acute Intracerebral Hemorrhage: A CT Perfusion Study.
abstract: OBJECTIVE
  Although blood pressure reduction has been postulated to result in a fall in cerebral perfusion pressure in patients with intracerebral hemorrhage, the latter is rarely measured. We assessed regional cerebral perfusion pressure in patients with intracerebral hemorrhage by using CT perfusion source data.
  
  
  METHODS
  Patients with acute primary intracerebral hemorrhage were randomized to target systolic blood pressures of <150 mm Hg (n = 37) or <180 mm Hg (n = 36). Regional maps of cerebral blood flow, cerebral perfusion pressure, and cerebrovascular resistance were generated by using CT perfusion source data, obtained 2 hours after randomization.
  
  
  RESULTS
  Perihematoma cerebral blood flow (38.7 ± 11.9 mL/100 g/min) was reduced relative to contralateral regions (44.1 ± 11.1 mL/100 g/min, P = .001), but cerebral perfusion pressure was not (14.4 ± 4.6 minutes(-1) versus 14.3 ± 4.8 minutes(-1), P = .93). Perihematoma cerebrovascular resistance (0.34 ± 0.11 g/mL) was higher than that in the contralateral region (0.30 ± 0.10 g/mL, P < .001). Ipsilateral and contralateral cerebral perfusion pressure in the external (15.0 ± 4.6 versus 15.6 ± 5.3 minutes(-1), P = .15) and internal (15.0 ± 4.8 versus 15.0 ± 4.8 minutes(-1), P = .90) borderzone regions were all similar. Borderzone cerebral perfusion pressure was similar to mean global cerebral perfusion pressure (14.7 ± 4.7 minutes(-1), P ≥ .29). Perihematoma cerebral perfusion pressure did not differ between blood pressure treatment groups (13.9 ± 5.5 minutes(-1) versus 14.8 ± 3.4 minutes(-1), P = .38) or vary with mean arterial pressure (r = -0.08, [-0.10, 0.05]).
  
  
  CONCLUSIONS
  Perihematoma cerebral perfusion pressure is maintained despite increased cerebrovascular resistance and reduced cerebral blood flow. Aggressive antihypertensive therapy does not affect perihematoma or borderzone cerebral perfusion pressure. Maintenance of cerebral perfusion pressure provides physiologic support for the safety of blood pressure reduction in intracerebral hemorrhage.
authors.affiliation: Department of Diagnostic Imaging (A.S.T., D.J.E.), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: A S
authors.initials: AS
authors.lastname: Tamm
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: R
authors.initials: R
authors.lastname: McCourt
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: B
authors.initials: B
authors.lastname: Gould
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: M
authors.initials: M
authors.lastname: Kate
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: J C
authors.initials: JC
authors.lastname: Kosior
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: T
authors.initials: T
authors.lastname: Jeerakathil
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: L C
authors.initials: LC
authors.lastname: Gioia
authors.affiliation: Division of Neurology (D.D.), University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Dowlatshahi
authors.affiliation: Department of Clinical Neurosciences (M.D.H., S.B.C., A.M.D.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: M D
authors.identifier: http://orcid.org/0000-0002-6269-1543
authors.initials: MD
authors.lastname: Hill
authors.affiliation: Department of Clinical Neurosciences (M.D.H., S.B.C., A.M.D.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: S B
authors.initials: SB
authors.lastname: Coutts
authors.affiliation: Department of Clinical Neurosciences (M.D.H., S.B.C., A.M.D.), University of Calgary, Calgary, Alberta, Canada.
authors.forename: A M
authors.identifier: http://orcid.org/0000-0002-4930-7789
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: B H
authors.initials: BH
authors.lastname: Buck
authors.affiliation: Department of Diagnostic Imaging (A.S.T., D.J.E.), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: D J
authors.initials: DJ
authors.lastname: Emery
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.).
authors.forename: A
authors.initials: A
authors.lastname: Shuaib
authors.affiliation: From the Division of Neurology (R.M., B.G., M.K., J.C.K., T.J., L.C.G., B.H.B., A.S., K.S.B.) ken.butcher@ualberta.ca.
authors.forename: K S
authors.initials: KS
authors.lastname: Butcher
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents