Background:
Current American Heart Association guidelines for targeted blood pressure management in spontaneous intracerebral hemorrhage (ICH), published in 2010, suggest a target mean arterial pressure of less than 110 or a blood pressure of less than 160/90 in patients without elevated intracranial pressure. These guidelines acknowledge that these recommendations have been based on incomplete efficacy evidence. A lower level recommendation was given for reducing target blood pressure to a systolic of 140, based on the INTERACT trial published in 2008. The INTERACT2 trial, published in May 2013, has been interpreted to establish the safety of rapid blood pressure lowering to 140 systolic.
Purpose:
To determine the current level of adoption by stroke centers of lower targets for blood pressure in patients with spontaneous intracerebral hemorrhage, and whether these targets have changed in 2013.
Methods:
We developed a web-based survey that was distributed via email and professional groups to stroke advanced practice nurses and stroke program coordinators. The survey asked specific questions regarding changes in clinical practice and stroke center policies on blood pressure management in spontaneous ICH. The survey was anonymous, and the survey software was able to exclude multiple entries from the same computer.
Results:
Responses were obtained from academic medical centers, community teaching hospitals, and community non-teaching hospitals. Awareness of the results of INTERACT2 was known by 65%, 50%, and 31% of stroke nurses at these hospitals, respectively. Targets for systolic blood pressure were changed in 2013 at 46%, 44%, and 11% of hospitals by group. A time target to lower blood pressure of less than one hour was adopted by 57%, 46%, and 28% respectively.
Conclusion:
Stroke centers have rapidly adopted changes in blood pressure management in intracerebral hemorrhage in advance of guideline revisions. Non-teaching hospitals were less likely to adopt these changes.
Response by Ziai et al to Letter Regarding Article, “Blood Pressure Variability Predicts Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage”