Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

CV
Source: 
Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage June 8, 2016DOI: 10.1056/NEJMoa1603460

Optimal blood pressure management for intracerebral hemorrhage (ICH) patients remains unclear. In a prospective randomized clinical trial, patients with ICH volume <60 cm3 and Glasgow Coma Scale (GCS) score of >5 were randomized to a systolic blood pressure of 110-139 mm Hg (intensive treatment) or 140-179 mm Hg (standard treatment).  In 1000 participants with a mean (±SD) systolic admission blood pressure of 200.6±27.0 mm Hg, 500 were assigned to intensive treatment and 500 to standard treatment.  Enrollment was stopped after a pre-specified interim analysis. The primary outcome of death or disability was observed in 38.7% (186 of 481) of the intensive treatment group and in 37.7% (181 of 480) of the standard treatment group.  1.6% of the intensive treatment patients and 1.2% of the standard treatment group had serious adverse events occurring within 72 hours after randomization that were considered by investigators as treatment-related, but the renal complication rate was higher in the intensive treatment cohort. This trial does not support an acute systolic blood pressure goal of 110-139 mm Hg in ICH patients.

Robert Starke, MD, MSc
Miami, FL