Intracranial Hemorrhage Patients Better Off After Having Blood Pressure Lowered Even More
April 7, 2008
Intracranial Hemorrhage Patients Better Off After Having Blood PressureLowered Even More
An article in The Lancet Neurology suggests that inindividuals who have had intracranial hemorrhage, hematoma growth canbe reduced by lowering their blood pressure even further than whatexisting guidelines recommend.
A patient’s blood pressure can rapidly increase due to intracranialhemorrhage (bleeding within the skull). This condition often leads tofurther hemorrhage and the growth of an area of internal bleeding(hematoma) that worsens the patient’s condition. Due to increasedpressure on important brain structures, the condition also increasesthe risk of early death or residual disability. It is common practiceto quickly lower very high blood pressure after a hemorrhage, but thereis still some debate about exactly when to begin the treatment and howmuch to lower blood pressure. In clinical situations around the world,there is considerable variation in high blood pressure management.
To compare standard treatment strategy with a more intensive one, DrCraig Anderson (The George Institute for International Health, Sydney,Australia) and colleagues designed a randomized pilot trial withparticipating hospitals in Australia, China and South Korea betweenNovember 2007 and August 2007. One group of patients (203 individuals)received an intensive blood-pressure-lowering strategy, targetingsystolic blood pressure at 140 mm Hg. A second group (201 individuals)received the recommended best practice standard strategy, targetingsystolic blood pressure at 180 mm Hg. All patients had spontaneousintracerebral hemorrhage.
In order to be included in the trial, doctors confirmed eachparticipant’s diagnosis using a CT (computerized tomography).Twenty-four hours after treatment, patients received another CT scan tocheck for hematoma growth. Hematoma growth in the intensivetreatment group was significantly lower than in the standard treatmentgroup: 13.7% vs. 36.3%, respectively. In addition, there were nosignificant differences in the numbers of adverse side-effects or inany of the secondary clinical outcomes - number ofdeaths, degrees of disability, physical and mentalfunctioning, and quality of life in survivors 90 days after treatment.
“Because intravenous treatment to lower blood pressure is relativelystraightforward, is not hazardous, and is of low cost, if appliedwidely these effects could translate into major absolute benefits,”conclude the researchers.
An accompanying Comment, written by Dr Mustapha Ezzeddine (Universityof Minnesota, Minneapolis, USA) notes: “The INTERACT trial representsthe best evidence to date of the safety of such an intervention”. Headds that although many questions - such as whether these results aregeneralisable to other stroke patients and how long blood pressureneeds to be controlled for - remain unanswered, the follow-up studies ofINTERACT, and a related trial ATACH2, “will be able to answer some ofthese questions, but more importantly, detect any impact on outcomes”.
Intensive blood pressure reduction in acute cerebral haemorrhage trial(INTERACT): a randomised pilot trial
Craig S Anderson, Yining Huang, Ji Guang Wang, HisatomiArima, Bruce Neal, Bin Peng, Emma Heeley, Christian Skulina, Mark WParsons, Jong Sung Kim, Qing Ling Tao, Yue Chun Li, Jian Dong Jiang, LiWen Tai, Jin Li Zhang, En Xu, Yan Cheng, Stephane Heritier, Lewis BMorgenstern, John Chalmers.
The Lancet Neurology. April5,2008.
doi:10.1016/S1474-4422(08)70069-3
ClickHere to View Journal Website
Written by: Peter M Crosta
Copyright: Medical News Today
