Effect of Race–Ethnicity and CT Angiography on Renal Injury During Blood Pressure Treatment for Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Nayna Shah ◽  
Sebastian Koch ◽  
Zakariya Hassouneh ◽  
Antonio Bustillo ◽  
Marialaura Simonetto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Renal Injury ◽  
Pressure Treatment ◽  
Blood Pressure Treatment ◽  
Race Ethnicity

Abstract WP419: Effect of Race-Ethnicity and Ct Angiography on Acute Kidney Injury During Blood Pressure Treatment for Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Emma H Boslet ◽  
Nayna Shah ◽  
Marialaura Simonetto ◽  
Antonio Bustillo ◽  
Kristine H O'Phelan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Intracerebral Hemorrhage ◽  
Ct Angiography ◽  
Real Life ◽  
Kidney Injury ◽  
Linear Regression Models ◽  
Absolute Increase ◽  
Blood Pressure Treatment ◽  
Race Ethnicity

Background: Lowering blood pressure intensively in acute intracerebral hemorrhage (ICH) is associated with acute kidney injury (AKI). Blacks have a higher incidence of ICH as well as kidney disease. In addition, CT angiography (CTA), which may also be associated with AKI, is often done in acute ICH. Our objective was to investigate the relationship between aggressive BP management, CTA, race ethnicity and the risk of developing AKI in patients presenting with ICH. Methods: Patients with spontaneous ICH hospitalized in 2017 and 2018 were included. Patients with underlying arteriovenous malformations, brain metastases, and aneurysms, were excluded. We calculated the difference between the highest and lowest systolic blood pressure (SBP) during the first 24 hours of admission. Creatinine levels at admission were compared to the highest creatinine during the first 7 days after admission. AKI was defined as absolute increase in creatinine of >0.3 or 50% increase from baseline creatinine. Linear regression models were used to assess the association between SBP difference, history of CTA and AKI. Results: A total of 289 patients were included (mean±SD age 63±13), 40% were women, 41% Hispanics and 47% blacks. The majority of the patients underwent CTA (71%). The prevalence of AKI was high (30%). Blacks showed a significantly higher SBP compared to whites and Hispanics (p=.02), but no difference was found in AKI incidence (33% in Blacks vs. 27% in Caucasians and Hispanics (p=0.7). Higher BUN, creatinine and SBP on admission were associated with AKI (p=.001, p<.0001, and p=.0001, respectively). Those who developed AKI had a greater mean drop of SBP in 24 hours compared to those who did not (103mmHg vs. 84mmHg, p=.0007) and a higher prevalence of diabetes (p=.0013). In fully adjusted models, AKI was associated with SBP drop (p=.0003), but not with race/ethnicity (p=.6) or CTA (p=.06). Conclusion: We confirm, in a real-life ICH population, the association between intense blood pressure lowering and development of AKI. Race/ ethnicity and CTA were not independently associated with AKI. Our findings do not suggest that obtaining a CTA in acute ICH poses significant additional risks on developing AKI.

Acute Hypertensive Response in Patients With Acute Intracerebral Hemorrhage: A Narrative Review

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012276
Author(s):  
Maximiliano A. Hawkes ◽  
Alejandro A. Rabinstein
Keyword(s):  
Blood Pressure ◽  
Clinical Trials ◽  
Intracerebral Hemorrhage ◽  
Clinical Outcomes ◽  
Randomized Clinical Trials ◽  
Hematoma Expansion ◽  
Pressure Treatment ◽  
Blood Pressure Treatment ◽  
Acute Intracerebral Hemorrhage ◽  
Intensive Blood Pressure

ObjectiveTo review the role of the acute hypertensive response in patients with intracerebral hemorrhage, current treatment options and areas for further research.MethodsReview of the literature to assess 1) Frequency of acute hypertensive response in intracerebral hemorrhage 2) Consequences of acute hypertensive response in clinical outcomes 3) Acute hypertensive response and secondary brain injury: hematoma expansion and perihematomal edema 4) Vascular autoregulation, safety data side effects of acute antihypertensive treatment, and 5) Randomized clinical trials and meta-analyses.ResultsAn acute hypertensive response is highly frequent in patients with acute intracerebral hemorrhage, and it is associated with poor clinical outcomes. However, it is not clear whether high blood pressure is a cause poor clinical outcome, or it solely represents a marker of severity. Although current guidelines recommend intensive blood pressure treatment (<140 mmHg) in patients with intracerebral hemorrhage, two randomized clinical trials have failed to demonstrate a consistent clinical benefit from this approach, and new data suggest that intensive blood pressure treatment could be beneficial for some patients, but detrimental for others.ConclusionsIntracerebral hemorrhage is a heterogenous disease, thus, a one-fit-all approach for blood pressure treatment may be suboptimal. Further research should concentrate on finding subgroups of patients more likely to benefit from aggressive BP lowering, considering ICH etiology, ultra-early randomization and risk markers of hematoma expansion on brain imaging.

Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older

2017 ◽  
Vol 167 (4) ◽  
pp. 288
Author(s):  
Gulistan Bahat ◽  
Birkan Ilhan ◽  
Asli Tufan ◽  
Mehmet Akif Karan
Keyword(s):  
Blood Pressure ◽  
Pressure Treatment ◽  
Blood Pressure Treatment ◽  
Intensive Blood Pressure

scholarly journals Risk–benefit profile of intensive blood pressure treatment

2018 ◽  
Vol 6 (8) ◽  
pp. 601-602 ◽  
Author(s):  
João Sérgio Neves ◽  
Lia Leitão ◽  
Rita Magriço ◽  
Catarina Viegas Dias ◽  
Miguel Bigotte Vieira
Keyword(s):  
Blood Pressure ◽  
Pressure Treatment ◽  
Blood Pressure Treatment ◽  
Intensive Blood Pressure

scholarly journals Impact of cumulative SBP and serious adverse events on efficacy of intensive blood pressure treatment

2019 ◽  
Vol 37 (5) ◽  
pp. 1058-1069 ◽  
Author(s):  
Oscar L. Rueda-Ochoa ◽  
Lyda Z. Rojas ◽  
Shahzad Ahmad ◽  
Cornelia M. van Duijn ◽  
Mohammad A. Ikram ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Adverse Events ◽  
Pressure Treatment ◽  
Serious Adverse Events ◽  
Blood Pressure Treatment ◽  
Intensive Blood Pressure

Blood pressure treatment levels and choice of antihypertensive agent in people with diabetes mellitus

2017 ◽  
Vol 35 (3) ◽  
pp. 453-462 ◽  
Author(s):  
Mattias Brunström ◽  
Mats Eliasson ◽  
Peter M. Nilsson ◽  
Bo Carlberg
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Antihypertensive Agent ◽  
Pressure Treatment ◽  
Blood Pressure Treatment
Sign in / Sign up

Export Citation Format

Share Document