ICH: Intensive SBP Reduction May Be Tied to Neurological Deterioration Among Patients With Excessively High Initial SBP

Intensive systolic blood pressure reduction may be associated with higher rates of neurological deterioration compared with standard systolic blood pressure reduction among patients with intracerebral hemorrhage and an initial systolic blood pressure of at least 220 mm Hg, according to new findings published in JAMA Neurology.

“The significantly higher rate of neurological deterioration associated with intensive treatment in patients with initial systolic blood pressure of 220 mm Hg or more warrants caution against broad recommendations for intensive systolic blood pressure reduction in patients with intracerebral hemorrhage,” the authors wrote.

They arrived at their conclusion after performing a post hoc analysis in November 2019 based on data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage-II trial, which was performed from May 2011 to September 2015. Participants in the analysis had intracerebral hemorrhage, initial systolic blood pressure of at least 180 mm Hg or more, and had been randomly assigned to an intensive or standard intervention within 4.5 hours after the onset of symptoms (N = 999).

The main outcomes of the study included neurological deterioration and hematoma expansion within 24 hours and death or severe disability at 90 days, as well as adverse events and serious adverse events of the kidneys until day 7 or discharge from the hospital.

A total of 228 participants included in the present analysis had initial systolic blood pressures of at least 220 mm Hg. The results of the study indicated that participants who underwent intensive systolic blood pressure reduction had a higher rate of neurological deterioration within 24 hours compared with those who underwent standard systolic blood pressure reduction (15.5% vs 6.8%, with a relative risk of 2.28). The authors observed no significant between-group differences in the rates of death and severe disability (39.0% vs 38.4%, with a relative risk of 1.02).

The authors also observed a significantly higher rate of adverse events involving the kidneys among participants who underwent intensive systolic blood pressure reduction compared with standard blood pressure reduction (13.6% vs 4.2%, with a relative risk of 3.22). However, no significant between-group difference was observed for the rate of serious adverse events of the kidneys.

—Christina Vogt

Reference:
Qureshi AI, Huang W, Lobanova I, et al. Outcomes of intensive systolic blood pressure reduction in patients with intracerebral hemorrhage and excessively high initial systolic blood pressure: post hoc analysis of a randomized clinical trial. JAMA Neurol. Published online September 8, 2020. doi:10.1001/jamaneurol.2020.3075