Abstract WP305: Impact of Potential Systolic Blood Pressure Treatment Thresholds on Hematoma Growth in Acute Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
David Rodriguez-Luna ◽  
Marta Rubiera ◽  
Marian Muchada ◽  
Pilar Coscojuela ◽  
Marc Ribo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Statistical Significance ◽  
Secondary Analysis ◽  
Hematoma Enlargement ◽  
Treatment Thresholds ◽  
Hematoma Growth ◽  
Acute Intracerebral Hemorrhage ◽  
The Impact

Background: Although the current AHA guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg in acute intracerebral hemorrhage (ICH), little is known about the relationships between different therapeutic target thresholds and hematoma growth (HG). Therefore, we aimed to investigate the impact of potential SBP treatment thresholds on HG in patients with acute ICH. Methods: This study was a secondary analysis of data prospectively collected during a previously reported study of the impact of blood pressure (BP) on HG in 106 patients with acute (<6 hours) supratentorial ICH. Patients underwent baseline and 24-hour computed tomography scans, and noninvasive BP monitoring at 15 minutes interval over first 24 hours. SBP loads were defined as the percentage of 24-hour SBP monitoring values exceeding 140, 150, 160, 170, 180, 190, and 200 mmHg. HG was defined as a relative enlargement greater than 33% or an absolute expansion more than 6 mL at 24 hours. Results: Patients who experienced HG (34%) presented higher SBP loads in all thresholds, reaching statistical significance in 170, 180, and 190 thresholds, but not in the others (Figure). Whilst SBP load thresholds were correlated neither with baseline nor 24-hour ICH volumes, highest (170 to 200) but not lowest (140 to 160) SBP load thresholds were significantly correlated with the amount of both relative and absolute hematoma enlargement at 24 hours (p<0.05). In multivariate analyses, both SBP 170-load (OR 1.034, 95% CI 1.001-1.070, p=0.048) and 180-load (OR 1.052, 95% CI 1.010-1.097, p=0.016) were independently related to HG. Conclusions: In patients with acute supratentorial ICH, those who experience HG present higher SBP load from 140 to 200 mmHg thresholds. More intensive SBP-lowering treatment than guidelines recommendations is needed, at least below 170 mmHg, in order to minimize the deleterious effect of higher SBP on HG.

scholarly journals Lower Treatment Blood Pressure Is Associated With Greatest Reduction in Hematoma Growth After Acute Intracerebral Hemorrhage

Hypertension ◽  
2010 ◽  
Vol 56 (5) ◽  
pp. 852-858 ◽  
Author(s):  
Hisatomi Arima ◽  
Craig S. Anderson ◽  
Ji Guang Wang ◽  
Yining Huang ◽  
Emma Heeley ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Lower Treatment ◽  
Hematoma Growth ◽  
Acute Intracerebral Hemorrhage

Statistical analysis plan for pooled individual patient data from two landmark randomized trials (INTERACT2 and ATACH-II) of intensive blood pressure lowering treatment in acute intracerebral hemorrhage

2018 ◽  
Vol 14 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Tom J Moullaali ◽  
Xia Wang ◽  
Renee' H Martin ◽  
Virginia B Shipes ◽  
Adnan I Qureshi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Systolic Blood Pressure ◽  
Functional Recovery ◽  
Modified Rankin Scale ◽  
Blood Pressure Lowering ◽  
Safety Outcomes ◽  
Pressure Lowering ◽  
Acute Intracerebral Hemorrhage ◽  
Intensive Blood Pressure

Background There is persistent uncertainty over the benefits of early intensive systolic blood pressure lowering in acute intracerebral hemorrhage. In particular, over the timing, target, and intensity of systolic blood pressure control for optimum balance of potential benefits (i.e. functional recovery) and risks (e.g. cerebral ischemia). Aims To determine associations of early systolic blood pressure lowering parameters and outcomes in patients with a hypertensive response in acute intracerebral hemorrhage. Secondary aims are to identify the modifying effects of patient characteristics and an optimal systolic blood pressure lowering profile. Methods Individual participant data pooled analyses of two large, multicenter, randomized controlled trials specifically undertaken to assess the effects of early intensive systolic blood pressure reduction on clinical outcomes in acute intracerebral hemorrhage: the Intensive Blood Pressure in Acute Intracerebral Hemorrhage Trial (INTERACT2) and the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH-II) trial. Combined data will include baseline characteristics; systolic blood pressure in the first 24 h; process of care measures; and key efficacy and safety outcomes. Outcomes The primary outcome is functional recovery, defined by an ordinal distribution of scores on the modified Rankin scale at 90 days post-randomization. Secondary outcomes include various standard binary cut-points for disability-free survival on the modified Rankin scale, and health-related quality of life at 90 days. Safety outcomes include symptomatic hypotension requiring corrective therapy and early neurologic deterioration within 24 h, and deaths, any serious adverse event, and cardiac and renal serious adverse events, within 90 days. Discussion A pre-determined protocol was developed to facilitate successful collaboration and reduce analysis bias arising from prior knowledge of the findings. Clinical trial registration URL: http://www.clinicaltrials.gov . Unique identifiers for INTERACT2 (NCT00716079) and ATACH-II (NCT01176565).

scholarly journals Earlier Blood Pressure-Lowering and Greater Attenuation of Hematoma Growth in Acute Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (8) ◽  
pp. 2236-2238 ◽  
Author(s):  
Hisatomi Arima ◽  
Yining Huang ◽  
Ji Guang Wang ◽  
Emma Heeley ◽  
Candice Delcourt ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Blood Pressure Lowering ◽  
Pressure Lowering ◽  
Hematoma Growth ◽  
Acute Intracerebral Hemorrhage

Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage

2013 ◽  
Vol 20 (9) ◽  
pp. 1277-1283 ◽  
Author(s):  
D. Rodriguez-Luna ◽  
S. Piñeiro ◽  
M. Rubiera ◽  
M. Ribo ◽  
P. Coscojuela ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Hematoma Growth ◽  
Acute Intracerebral Hemorrhage ◽  
Pressure Changes

Effect of Magnesium L-Lactate on Blood Pressure in Patients with an Implantable Cardioverter Defibrillator

2009 ◽  
Vol 43 (4) ◽  
pp. 559-576 ◽  
Author(s):  
William L Baker ◽  
Jeffrey Kluger ◽  
C Michael White ◽  
Krista M Dale ◽  
Burton B Silver ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Magnesium Deficiency ◽  
Statistical Significance ◽  
Serum Magnesium ◽  
Blood Pressure Reduction ◽  
Intracellular Magnesium ◽  
Time Period ◽  
The Impact ◽  
Oral Magnesium

Background: Previous studies have evaluated the impact of oral magnesium on blood pressure; however, they used magnesium salts with low bioavailability, had methodological issues, and showed differing results. Objective: To evaluate the long-term blood pressure–lowering ability of oral magnesium L-lactate versus placebo in patients with implanted cardioverter defibrillators (ICDs). Methods: In this double-blind, 24-week trial, 50 patients with ICDs were randomized to receive magnesium L-lactate (6 tablets daily, supplying a total of 504 mg of elemental magnesium daily) or matching placebo for at least 12 weeks. Baseline intracellular and serum magnesium concentrations were determined. The primary efficacy endpoint was the mean sitting systolic blood pressure at 24 weeks. Results: In 50 patients who completed at least 12 weeks of follow-up, 86% of patients, regardless of randomization, had a baseline intracellular magnesium deficiency, but no patients had a serum magnesium deficiency. At 12 weeks, magnesium L-lactate significantly reduced systolic blood pressure compared with placebo (117.7 ± 11.8 vs 126.3 ± 16.7 mm Hg, respectively; p = 0.04). In the 45 patients who continued in the study through the 24-week time period, the systolic blood pressure reduction was maintained, but statistical significance was lost (118.1 ± 14.1 vs 125.5 ± 17.2 mm Hg, respectively; p = 0.13). Magnesium L-lactate did not impact diastolic blood pressure at either time period (p ≥ 0.75 for both). Patients with a documented history of hypertension at baseline showed similar qualitative results to the primary analysis. Conclusions: A large number of subjects with ICDs have an intracellular magnesium deficiency not captured through serum magnesium determination. The use of magnesium L-lactate in patients with an ICD results in significant improvement in systolic blood pressure at 12 weeks, which may be maintained through 24 weeks.

scholarly journals Clinical Strategies Against Early Hematoma Expansion Following Intracerebral Hemorrhage

2021 ◽  
Vol 15 ◽  
Author(s):  
Kanta Tanaka ◽  
Kazunori Toyoda
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Stroke Onset ◽  
Factor Vii ◽  
Hematoma Expansion ◽  
Thrombin Inhibitor ◽  
Small Magnitude ◽  
Hematoma Enlargement ◽  
Significant Difference ◽  
Hematoma Growth

Hematoma volume is the strongest predictor of morbidity and mortality after intracerebral hemorrhage. Protection against early hematoma growth is therefore the mainstay of therapeutic intervention for acute intracerebral hemorrhage, but the current armamentarium is restricted to early blood pressure lowering and emergent reversal for anticoagulant agents. Although intensive lowering of systolic blood pressure to &lt;140 mmHg appears likely to prevent hematoma growth, two recent randomized trials, INTERACT-2 and ATACH-2, demonstrated non-significant trends of reduced hematoma enlargement by intensive blood pressure control, with only a small magnitude of benefit or no benefit for clinical outcomes. While oral anticoagulants can be immediately reversed by prothrombin complex concentrate, or the newly developed idarucizumab for direct thrombin inhibitor or andexanet for factor Xa inhibitors, the situation regarding reversal of antiplatelet agents is not yet quite as advanced. However, considering at most the approximately 10% rate of anticoagulant use among patients with intracerebral hemorrhage, what is most essential for patients with intracerebral hemorrhage in general is early hemostatic therapy. Tranexamic acid may safely reduce hematoma expansion, but its hemostatic effect was insufficient to be translated into improved functional outcomes in the TICH-2 randomized trial with 2,325 participants. In this context, recombinant activated factor VII (rFVIIa) is a candidate to be added to the armory against hematoma enlargement. The FAST, a phase 3 trial that compared doses of 80 and 20 μg/kg rFVIIa with placebo in 841 patients within 4 h after the stroke onset, showed a significant reduction in hematoma growth with rFVIIa treatment, but demonstrated no significant difference in the proportion of patients with severe disability or death. However, a post hoc analysis of the FAST trial suggested a benefit of rFVIIa in a target subgroup of younger patients without extensive bleeding at baseline when treated earlier after stroke onset. The FASTEST trial is now being prepared to determine this potential benefit of rFVIIa, reflecting the pressing need to develop therapeutic strategies against hematoma enlargement, a powerful but modifiable prognostic factor in patients with intracerebral hemorrhage.

scholarly journals Preventive Effect of Aggressive Blood Pressure Lowering on Hematoma Enlargement in Patients With Ultra-acute Intracerebral Hemorrhage

2010 ◽  
Vol 50 (11) ◽  
pp. 966-971 ◽  
Author(s):  
Tomofumi NISHIKAWA ◽  
Tetsuya UEBA ◽  
Motohiro KAJIWARA ◽  
Ryoichi IWATA ◽  
Naomi MIYAMATSU ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Blood Pressure Lowering ◽  
Preventive Effect ◽  
Hematoma Enlargement ◽  
Pressure Lowering ◽  
Acute Intracerebral Hemorrhage
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