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

Post-hoc analysis of 228 patients with initial systolic blood pressures (SBP) >220 mm Hg found that the rate of neurological deterioration within 24 hours was higher in those who underwent intensive vs standard SBP reduction (15.5% vs 6.8%; RR 2.28, 95%CI 1.03-5.07).

SPS commentary:

A related editorial comments that this study contributes to a growing body of literature that explores whether the limited benefit of intensive blood pressure reduction observed in the general population of patients with intracerebral haemorrhage (ICH) is because of limited biological effect or instead because potential benefits are being counterbalanced by harms.  With this growing evidence, the landscape of patients and treatment approaches with favourable and unfavourable characteristics is becoming clearer. Data from other studies have showed that achieving and sustaining early SBP reduction was associated with less haematoma expansion, less neurologic deterioration, and better functional outcomes. However favourable outcomes are generally uncommon in patients with high admission severity, and most patients in current trials had cases of mild to moderate severity. Observational data has recently suggested that the ideal SBP reduction trajectory depends on numerous individual factors and overcorrection is harmful, and that there is a window beyond which the potential benefit of SBP reduction may wane.


JAMA Neurology

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