Key Points:
- Study examines change in intracranial hematoma growth based on intensity of systolic BP control
- Intensive control associated with reduced growth
Rapid, sustained, and intensive control of blood pressure (BP) translates to smaller hematoma growth among patients with spontaneous intracerebral hemorrhage and elevated systolic BP, according to a brief report published online May 3, 2016, ahead of print in Stroke.
As part of the INTERACT2 trial, Craig S. Anderson, MD, PhD, of the George Institute for Global Health (Sydney, Australia), and colleagues analyzed the degree and timing of BP treatment.
They randomized 2,839 patients who had experienced a spontaneous intracerebral hemorrhage within the previous 6 hours and who had elevated systolic BP (150-220 mm Hg) to receive either intensive control (< 140 mm Hg within 1 hour) or guideline-recommended control (< 180 mm Hg). Systolic BP levels were measured every 15 minutes in the first hour postrandomization and then every 6 hours until 24 hours had elapsed.
Overall, 964 participants in the trial received repeat cranial CT at 24 hours. Among these patients, greater reduction in systolic BP was associated with reduced hematoma growth (table 1).
Among the 491 patients in the intensive treatment group, the least mean hematoma growth occurred in patients who achieved the target systolic BP within 1 hour (2.6 mL), compared with those who were within target at 1 to 6 hours (4.7 mL) or beyond 6 hours (5.4 mL). The smallest mean absolute hematoma growth (2.0 mL) occurred among patients who achieved target systolic BP for 5 to 8 readings, compared with 3 to 4 readings (3.1 mL) and 0 to 2 readings (5.2 mL).
Aim for Rapid, Intensive, and Sustained Control
“There has clearly been a shift in awareness about the importance of blood pressure control in the context of acute intracerebral hemorrhage, with a shift … from prior guideline recommendations of a systolic target of < 180 mm Hg,” Dr. Anderson told WLNCMD in an email.
“However, there are still challenges in the application of evidence into practice, especially in achieving good BP as early as possible after a patient presents to the emergency department of a hospital and in achieving a target of < 140 mm Hg,” he reported. “In part, this relates to communication/liaise issues between clinical disciplines of hospitals, and in part to the limitations of most intravenous BP lowering agents, which require careful titration of dosage to avoid overshooting or hypotensive effects if the dose is increased too rapidly.”
Valuably, he said, the study supplies “descriptive proof-of-concept mechanistic biological effects of early intensive BP lowering on the biomarker of hematoma growth from participants in the INTERACT clinical trials who had repeat brain imaging.” The findings, which support contemporary guidelines, reinforce the study’s previous results showing that achieving a systolic BP target of less than 140 mm Hg “is better sooner rather than later, from a higher rather than lower baseline level, and when it is more sustained (ie, with avoidance of fluctuations or systolic peaks),” Dr. Anderson noted.
Source:
- Carcel C, Wang X, Sato S, et al. Degree and timing of intensive blood pressure lowering on hematoma growth in intracerebral hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2 results. Stroke. 2016;Epub ahead of print.
Disclosures:
- Dr. Anderson reports being supported by The George Institute for Global Health, holding a senior principal research fellowship, receiving National Health and Medical Research Council grants, being a member of advisory boards for Astra Zeneca and Medtronic, and receiving travel reimbursement and honoraria from Takeda, China.
