scholarly journals Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective

2017 ◽  
Vol 9 (12) ◽  
pp. 448-453 ◽  
Author(s):  
Jose Gavito-Higuera ◽  
Rakesh Khatri ◽  
Ihtesham A Qureshi ◽  
Alberto Maud ◽  
Gustavo J Rodriguez
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Intracerebral Hemorrhage ◽  
Cerebral Hypoperfusion ◽  
Pressure Treatment ◽  
Blood Pressure Treatment ◽  
Hypertensive Intracerebral Hemorrhage ◽  
Imaging Perspective

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.

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

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

Abstract 39: Acute Blood Pressure Dysregulation Increases the Risk of Border Zone Ischemic Lesions in Hypertensive Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Szu-Ju Chen ◽  
Hsin-Hsi Tsai ◽  
Li-Kai Tsai ◽  
Ya-Fang Chen ◽  
Sung-Chun Tang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Border Zone ◽  
Cerebral Hypoperfusion ◽  
White Matter Hyperintensity ◽  
Roc Curve Analysis ◽  
The Difference ◽  
The Impact

Background: Intensive blood pressure (BP) reduction is regarded as the gold standard therapy for acute intracerebral hemorrhage (ICH), but its associations to cerebral hypoperfusion and ischemic lesions have been suspected. This study aims to investigate the impact of acute BP reduction on the development of acute ischemic lesions (AILs) at border zone (BZ) areas in patients with hypertensive ICH. Methods: We enrolled patients with acute hypertensive ICH (hemorrhagic lesions restricted to deep region [Strictly deep-ICH] or located in mixed lobar and deep areas [Mixed-ICH]) who received brain MRI within 7 days after ICH onset. BZ AILs were defined as lesions locating at BZ areas that were hyperintense on DWI sequence and hypointense on ADC series (figure). Acute SBP change was the difference between the initial SBP and the SBP recorded at 24 hours after ICH onset. Results: Of the 274 enrolled patients (62.5 ± 12.7 years old, 65% male), 11 subjects had BZ AILs. Compared to patients without BZ AILs, patients with lesions had wider amount of acute SBP reduction (71.7 ± 33.6 vs. 43.0 ± 32.2 mmHg, P = 0.023), more lobar and deep microbleeds (MB) and larger white matter hyperintensity volume (all p < 0.05). Using ROC curve analysis, acute SBP drop at more than 54mmHg was linked to the occurrence of AILs (sensitivity 82%, specificity 64%, P = 0.002). In multiple logistic regression model, acute SBP decline at above 54mmHg (OR 11.45, 95%CI 2.06 - 63.49, P = 0.005) and higher deep MB burden ( P = 0.032) raised the risk of AILs after adjustment for age, sex, and image markers of cerebral small vessel disease. In subgroup analysis, larger acute SBP drop remained to be an independent risk factor for development of AILs in patients with Mixed-ICH ( P = 0.008), but not in patients with strictly deep-ICH ( P = 0.715). Conclusion: Acute SBP change in hypertensive ICH, especially in Mixed-ICH, increases the risk of AILs at BZ areas, showing widespread microangiopathy that is vulnerable to rapid BP dysregulation to ischemia.

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
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